Abstract
Free full text
Nearly half of patients with migraine with aura are found to have a heart defect, study finds
A study has found that nearly half of a group of patients with long term migraine with aura had a heart defect. The defect was a right to left shunt caused by a patent foramen ovale.
The study, by cardiologists and neurologists at University Hospital, Bern, Switzerland, appeared online ahead of print publication on 7 September in Neurology (www.neurology.org/papbyrecent.html ). It used transoesophageal contrast echocardiography to examine the participants.
The study looked at a group of 93 patients who had had migraine with aura for an average of 18.5 years and 93 healthy control patients without migraine. The most common right to left shunt in adults, a patent foramen ovale (a remnant of fetal circulation), is present in around a quarter of the general population.
Forty four of the patients with migraine with aura and 16 of the control patients had the defect (odds ratio 4.56 (1.97 to 10.57)).
Among the patients in both groups with the defect, shunt size was on average larger in the patients with migraine with aura than in the control patients, and the presence of a moderate sized or large shunt increased the odds of having migraine with aura by 7.78 (95% confidence interval 2.53 to 29.3).
“Nearly half of all patients with migraine aura had a patent foramen ovale, and if present, the shunt size was larger when compared with the corresponding control group,” wrote the authors. “The presence of a more than small cardiac shunt increased the odds of having migraine with aura nearly 8-fold.”
“The uniqueness of this study is the use of transesophageal contrast echocardiography to prove that these shunts were patent foramina ovalia.”
The finding of a larger shunt size in patients with migraine with aura than in the control patients suggests a causal link, the authors say. “The dosēresponse relationship between shunt size and migraine likelihood lends further support to a causal association between them.”
“We acknowledge that other factors are certainly as important in migraine pathophysiology as right to-left shunting, simply because a patent foramen ovale is present in only half of patients with migraine with aura,” they write.
The authors say that a randomised clinical trial to investigate the effects of shunt closure on migraine frequency is now needed to verify the hypothesis that a patent foramen ovale contributes to migraine attacks.
Although the causal link between patent foramen ovale and migraine is still being investigated, a number of theories have been proposed. One is that substances such as serotonin pass through the ovale, bypass pulmonary circulation, and trigger a migraine attack. Another is that an embolism may pass through the right to left shunt. This theory is supported by a reduced frequency of migraine seen in patients who are started on oral anticoagulation. This observation cannot be explained by the serotonin theory, the authors say.
Articles from The BMJ are provided here courtesy of BMJ Publishing Group
Full text links
Read article at publisher's site: https://doi.org/10.1136/bmj.331.7520.800-d
Read article for free, from open access legal sources, via Unpaywall: https://europepmc.org/articles/pmc1246120
Citations & impact
Impact metrics
Citations of article over time
Alternative metrics
Discover the attention surrounding your research
https://www.altmetric.com/details/118457198
Article citations
Differences in the quality of primary medical care services by remoteness from urban settlements.
Qual Saf Health Care, 16(6):446-449, 01 Dec 2007
Cited by: 17 articles | PMID: 18055889 | PMCID: PMC2653180
Problems with performance related pay in primary care.
BMJ, 335(7619):523, 01 Sep 2007
Cited by: 3 articles | PMID: 17855285 | PMCID: PMC1976500
Deprivation and quality of primary care services: evidence for persistence of the inverse care law from the UK Quality and Outcomes Framework.
J Epidemiol Community Health, 60(11):917-922, 01 Nov 2006
Cited by: 59 articles | PMID: 17053278 | PMCID: PMC2465488