Restless legs syndrome and primary headaches: a clinical study

Based on recent data about the association between restless legs syndrome (RLS) and migraine, we performed an observational study on the occurrence of RLS in patients affected by primary headaches. Two hundred headache patients (149 women and 51 men) and 120 (90 women and 30 men) sex-and age-matched control subjects were included. In the headache group, migraine without aura (MO) was the most represented headache type (n=114), followed by the “mixed” group (n=40) with MO, migraine with aura (MA) and frequent episodic tension-type headache (ETTH) in various combinations, and by ETTH alone (n=22). The remaining patients suffered from MA alone (n=10 MA), episodic cluster headache (ECH n=12) and primary stabbing headache (n=2). RLS frequency was significantly higher in headache patients than in control subjects (22.4% vs. 8.3, p=0.002) independently of sex, although with a female preponderance (84%) in both groups. More than 60% (n=27) of RLS patients were affected by MO and 30% (n=13) by a combination of two headache types (p≥0.001), with a very low frequency of RLS for the other types of headache. No RLS patient had ECH. No statistical differences were observed among clinical characteristics of different types of headache in groups with and without RLS. In both headache and control groups, higher scores for depression and anxiety were more frequent in subjects with RLS compared with those without RLS. Furthermore, headache patients with RLS reported sleep disturbances more frequently compared to those without RLS (50.0% vs. 32.7%; p<0.0001) and showed a normal or underweight body mass index. Our data seem to confirm the existence of an association between RLS and primary headaches, particularly with migraine, as already demonstrated. The absence of RLS in ECH patients is very interesting. Many pathogenetic considerations about links between RLS and primary headaches could be given, the most fitting involving dopamine and melatonin.     

High prevalence of Dopaminergic Premonitory Symptoms in migraine patients with Restless Legs Syndrome: a pathogenetic link?

In order to assess the prevalence of Dopaminergic Premonitory Symptoms (DPS) in migraine patients with Restless Legs Syndrome (RLS), we chose migraine patients from a large Italian clinical headache population previously investigated for an association between primary headaches and RLS. We evaluated a total sample of 164 patients with migraine, in particular 114 with migraine without aura (MO), 10 with migraine with aura (MA) and 40 with MO and MA in various combinations between them or with episodic tension-type headache (ETTH), defined as a “mixed group”. About 20% of all migraine patients referred at least one of the following DPS: yawning, nausea, somnolence or food craving, confirming data already indicated in the literature. Among migraine patients with RLS (25.6%), DPS were referred from about half of the patients (47.6%) compared to those without RLS (47.6% vs. 13.1%; p<0.001). Based on migraine subtype, patients with MO referred DPS (26.3%) more frequently compared to the MA group and “mixed group” (12.0%, p<0.05), particularly in the presence of RLS (63.0% vs. 20.0%, p<0.01). No statistical differences were found between clinical and demographic data of the subgroups or related to medical conditions investigated (anxiety, depression, sleep disorders, body mass index). It is interesting that the chances of having RLS in migraine patients were more than 5 times higher in the presence of DPS. These results could support a hypothetical dopaminergic imbalance in RLS and migraine, as the dopamine is involved in the pathogenesis of both disorders and it is responsible for the migraine DPS reported above.     

The extent of right-to-left shunt fails to correlate with severity of clinical picture in migraine with aura

Abstract Several investigations have documented an increased incidence of right-to-left shunt (RLS) in migraine with aura (MA) and have emphasised its role in the physiopathology of aura; so far, however, no data are available concerning a possible correlation between the extent of the RLS and the clinical picture of MA patients. To investigate the possible relationship between the extent of the RLS, revealed by the number of microbubbles (MB) detected during transcranial Doppler with IV injection of ultrasound contrast (TCDc), and the clinical characteristics of MA (age at first onset of migraine, mean annual frequency of attacks and mean duration of the aura phase), 30 consecutive patients with typical aura and migraine headache positive on TCDc evaluation for RLS were enrolled. Permanent RLS was found in 12 patients and latent RLS was found in 18 patients; of these, 6 had a high-grade RLS, 5 medium-grade RLS and 7 low-grade RLS. No correlation has been documented between the number of MBs and the clinical parameters of both patients with latent shunts and those with permanent ones, nor between the clinical parameters of the two groups of patients. These data show that RLS does not seem to affect the clinical manifestation of MA and that the extent of RLS fails to correlate with the severity of the clinical picture of the disorder.     

中国偏头痛患者右向左分流阳性率及分流类型——一项全国多中心研究

背景 偏头痛与右向左分流（right-to-left shunt,RLS）的关系尚有争议。本研究旨在明确中国偏头痛 患者右向左分流的阳性率、分流类型以及分流量大小,分析偏头痛与右向左分流的关系。 方法 该研究为多中心-病例对照研究（北美临床研究注册号NCT0242569)。由中国9家分中心共同完 成,连续纳入2015年6月-2016年8月就诊于分中心且符合据第三版国际头痛疾病分类-β测试版（The International Classification of Headache Disorders 3rd Edition Beta Version,ICHD-3β）诊断偏头痛的患 者（18～65周岁）,为偏头痛组。偏头痛组共纳入931例（女性695例）,其中先兆偏头痛240例（女性174 例）,无先兆偏头痛691例（女性521例）。健康对照组共282例。 结果 先兆偏头痛组RLS阳性率和大量分流比例高于无先兆偏头痛组（63.7% vs 39.9%,P＜0.001; 32.1% vs 16.5%,P＜0.001）,两组中量和小量分流比例无差异（P =0.141;P =0.061）。无先兆偏头痛 组RLS阳性率和大量分流比例高于对照组（39.9% vs 29.4%,P＜0.001;16.5% vs 6.4%,P＜0.001）, 两组间中量和小量分流的比例无差异。 结论 偏头痛患者（包括有先兆和无先兆偏头痛患者）,右向左分流阳性率高于正常对照组,且以大 量右向左分流为主,中至小量右向左分流及分流的类型与对照组相比无差异。右向左分流,特别是大 量的右向左分流,可能与偏头痛有关。     

Prevalence of cardiac right left shunts in migraine: a population-based case–control study

We aimed to investigate the prevalence of cardiac right left shunts (RLS) in population-based samples of subjects with migraine with aura (n = 42), migraine without aura (n = 44) and controls without headache (n = 41). Cardiac RLS was assessed with transcranial Doppler sonography with intravenous injection of saline. Prevalence of RLS was highest in migraineurs with aura (45.2%) compared to migraineurs without aura (34.1%) and controls (41.5%). Permanent as opposed to latent RLS was more common among patients with migraine with aura (40.5%) than in patients with migraine without aura (23.3%) or controls (24.4%). Differences did not reach statistical significance between the three groups (p = 0.564 for RLS prevalence, p = 0.349 for prevalence of permanent shunts). Our data implicate a trend towards higher prevalence of RLS with larger shunts in subjects with migraine with aura.     

Prevalence and characteristics of right-to-left shunt in migraine with aura: a survey on 120 Italian patients

Many lines of research have suggested a relationship between migraine with aura (MA) and patent foramen ovale. Right-to-left shunt (RLS) of blood might explain both the occurrence of MA attacks, as well as the increased risk of ischaemic stroke in these patients. We evaluated the prevalence and the characteristics of RLS in a series of 120 MA patients, who were studied with contrast-enhanced Transcranial Doppler examination. We found RLS in 61 of them. A latent RLS was found in 28%, a permanent RLS in 72%, a shower-curtain pattern was detected in 52% of the studied patients.

     

Prevalence of restless legs syndrome in individuals with migraine: a systematic review and meta-analysis of observational studies

Objective

Recent studies have shown an association between migraine and restless legs syndrome (RLS), but RLS prevalence among individuals with migraine differs substantially across studies. The present work aimed to comprehensively assess available evidence to estimate RLS prevalence among individuals with migraine and non-migraine controls.

Method

Web of Science, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed databases were searched for observational and case-control studies of RLS prevalence among individuals with migraine. Eligible studies were meta-analyzed using Stata 12.0 software.

Results

Pooled RLS prevalence in migraine was 19%, and the prevalence was lower in Asia (16%) than outside Asia (21%). Pooled RLS prevalence was 18.8% among individuals with migraine with aura, and 18.5% among individuals with migraine without aura; the RLS prevalence in migraine with aura (MA) was higher than that of migraine without aura (MO) (OR 1.17, 95%CI 1.01–1.34; p?=?0.037). Pooled RLS prevalence in a case-control study was significantly higher among individuals with migraine (17.9%) than among non-migraine controls (7.1%) (OR 2.65, 95%CI 2.26–3.10; p?<?0.001).

Conclusion

Our meta-analysis provides the first reliable pooled estimate of RLS prevalence among individuals with migraine, and it provides strong evidence that RLS risk is higher among individuals with migraine than among controls.

     

Migraine with and without aura share the same pathogenic mechanisms

Migraine with aura and without aura share the same clinical features with respect to the headache, and differ nosologically in the presence or absence of aura. The mechanisms of aura generation are now becoming clearer, based on imaging studies, and a common migraine pathophysiology for all subtypes of migraine headaches now seems reasonable, as it would seem implausible that all of these neurological events have different pathogenic mechanisms. Both major subtypes of migraine clearly represent a perturbation of normal physiology and employ normal anatomic pathways to generate the aura and headache, similar to aura and a seizure. So what is the mechanism of migraine aura? Do migraine without aura patients have clinically silent aura? Migraine is after all defined as a clinical disorder and is the prototypic primary headache and thus its uniform pathogenesis must underlie all that we know about migraine clinically. This presentation will take the resolve that the migraine with and without aura share the same pathogenic mechanisms.

     

New international classification of migraine with aura (ICHD-2) applied to 362 migraine patients

The International Classification of Headache Disorders 2nd edition (ICHD-2) subdivides migraine with aura (MA) differently from the ICHD-1 and includes new diagnostic criteria. The aim of the present study was to evaluate how the new classification works in practice and in comparison with the ICHD-1. The patients were recruited from a screen of the Danish National Patient Registry and from Danish neurologists. We included 362 patients diagnosed with MA according to the ICHD-1 in a validated semistructured physician-conducted interview. According to the ICHD-2, 89% (322 of 362) had MA and 11% (40 of 362) had probable MA. The MA patients had one or more ICHD-2 subtype of MA: 54% (173 of 322) had typical aura with migraine headache (MA-MH), 40% (129 of 322) had typical aura with non-migraine headache (MA-NMH), 37% (120 of 322) had aura without headache (MA-WOH), and 7% (26 of 322) had basilar-type migraine (MA-B). Of patients with MA-MH 34% (59 of 173) had co-occurrence of MA-WOH, 9% (16 of 173) had co-occurrence of MA-B and 5% (8 of 173) had co-occurrence of both MA-WOH and MA-B. Of patients with MA-NMH 27% (35 of 129) had co-occurrence of MA-WOH. Only 6% (18 of 322) of the MA patients had exclusively MA-WOH and <1% (2 of 322) had exclusively MA-B. Patients with MA-MH had an earlier age at onset (P = 0.044), an increased lifetime number of MA attacks (P = 0.054) and a higher co-occurrence of migraine without aura (P = 0.002) than patients with MA-NMH. Patients with MA-B tended to have an earlier age at onset and more severe attacks and patients with MA-WOH had a higher age at onset and less severe attacks than patients with MA-MH. The variations between ICHD-2 subtypes of MA indicate that patients with similar subtype of MA share phenotype and very likely have similar underlying aetiology.     

Should women suffering from migraine with aura be screened for biological thrombophilia?: Results from a cross-sectional French study

Introduction

Migraine, particularly migraine with aura (MA), is associated with a higher risk for ischemic stroke (IS). A procoagulant state may predispose to IS. Whether inherited biological thrombophilia are associated with migraine risk remains controversial.

Objective

To assess the risk of migraine without or with aura related to inherited biological thrombophilia adjusted for the main potential confounders.

Material and Methods

A cross-sectional study was conducted in 1456 French women aged 18 to 56 years, referred for biological coagulation check-up because of personal or familial venous thrombosis history. Between April 2007 and December 2008, all women answered a self-administered questionnaire to determine whether they had headache.

Results

There were 294 (20%) migrainous sufferers (including 71 [5%] with MA), 975 (67%) non migrainous women and 187 (13%) non migrainous headache women. Inherited thrombophilia were detected in 576 (40%) women, including 389 (40%) non migrainous women, 90 (40%) migraine without aura (MWA), 33 (46%) MA women and 64 (34%) non migrainous headache women. Factor V Leiden (FVL) i.e. F5rs6025 or Factor II G20210A (FIIL) i.e. F2rs1799963 mutation was detected in 296 (30%) non migrainous women and in 100 (34%) migrainous women of which 27 had MA. There was a significant association between MA and FVL or FIIL mutations (adjusted OR = 1.76 [95% CI 1.02-3.06] p = 0.04) whereas this association in MWA and in non migrainous headache women was not significant. There was no significant association between migraine and other biological thrombophilia.

Conclusion

FVL or FIIL mutations were more likely among patients suffering from MA. Whether biological thrombophilia screening should be systematically performed in women suffering from MA remains to be determined.     

Very high prevalence of right-to-left shunt on transcranial Doppler in an Italian family with cerebral autosomal dominant angiopathy with subcortical infarcts and leukoencephalopathy.

BACKGROUND AND PURPOSE: Cerebral autosomal dominant angiopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominant hereditary disease whose clinical expression is a stepwise subcortical vascular dementia. Initial presentation of the disease involves transient or stabilized focal neurological deficits, migraine and mood changes. Recently, a high prevalence of right-to-left shunt (RLS) due to patent foramen ovale has been reported in subjects with migraine. The aim of our study was to determine the prevalence of RLS in CADASIL with and without migraine. METHODS: We performed transcranial Doppler with gaseous contrast in 5 members of an Italian family with CADASIL, diagnosed by means of genetic and skin biopsy criteria. We then compared the prevalence of RLS in 40 consecutive subjects with juvenile stroke, 80 asymptomatic subjects affected by migraine with aura and 50 normal controls. RESULTS: A very high prevalence of RLS was found in CADASIL patients (4/5, 80%), as opposed to young subjects with ischemic stroke (15/40, 37%), asymptomatic subjects with migraine (32/80, 40%) and normal controls (8/50, 16%). All the subjects with CADASIL and migraine (4/4) showed RLS. The difference between CADASIL patients and controls was highly significant (p = 0.006). CONCLUSIONS: We suggest an association between CADASIL and RLS, possibly due to the abnormal development of the endocardial cushion influenced by Notch 3 mutation. Our hypothesis needs to be tested in larger samples.     

Anger and impulsiveness in migraine patients with and without aura

ABSTRACT

Background and purpose: Migraine is a common primary headache disorder triggered by internal or external stimuli. Impulsitivity and anger are associated with many neurological and psychiatric disorders. The aim of this study was to investigate the anger and impulsivity in migraine patients with or without aura.

Methods: A total of 55 patients aged between 18 and 55, who were diagnosed with episodic migraine (31 with aura and 24 without aura) and 40 healthy controls were enrolled in this prospective cross-sectional study.

Migraine diagnosis and classification were based on criteria from the International Classification of Headache Disorders, 3rd edition (beta version). Multidimensional Anger Scale and Barratt Impulsivity Scale-11 were administered to the patient and control groups.

Results:Migraine patients with aura, migraine patients without aura and control groups were compared, anger symptoms were significantly higher in migraine patients with aura (p < 0.001), but between these groups there was no significant difference in terms of impulsivity (p = 0.711).

Conclusions: It was found that anger symptoms were more common in migraine patients with aura compared to migraine patients without aura and control group, but in impulsitivity there was no difference between groups.

Further studies in future investigating the relation between migraine with aura and anger may pave the way for different and more specified treatment approach.     

Prevalence and characteristics of right-to-left shunt in migraine with aura: a survey on 120 Italian patients

Many lines of research have suggested a relationship between migraine with aura (MA) and patent foramen ovale. Right-to-left shunt (RLS) of blood might explain both the occurrence of MA attacks, as well as the increased risk of ischaemic stroke in these patients. We evaluated the prevalence and the characteristics of RLS in a series of 120 MA patients, who were studied with contrast-enhanced Transcranial Doppler examination. We found RLS in 61 of them. A latent RLS was found in 28%, a permanent RLS in 72%, a shower-curtain pattern was detected in 52% of the studied patients.     

Stroke in patients with migraine

Background and purposeMigraine with aura (MA) is considered as a risk factor for ischaemic stroke. The present observational retrospective study compares migraine patients admitted for a documented stroke with those presenting focal neurological symptoms and headache without a demonstrable lesion and in which the final diagnosis was a migraine attack with aura.Material and methodsThe study included 14 migraine patients with a stroke and 37 without a stroke. The clinical characteristics, the vascular risk factors and the results of the technical examinations were compared.ResultsStroke occurred in migraine patients with aura as well as without aura. Classical vascular risk factors were rather rare. Patent foramen ovale (PFO) with or without atrial septum aneurysm appeared to be the main risk factor for stroke in patients with a history of migraine. Infarcts were mainly located in the supratentorial territory of the posterior cerebral circulation. Also some lobar haematomas were observed, but their aetiology remained uncertain. The strokes were generally mildly severe with good outcome. Hyperintense signals in the cerebral white matter and cerebellum, on T₂-weighted magnetic resonance imaging, were more frequent in the migraine patients with stroke.ConclusionsThe presence of PFO, rather than of MA, appeared to be the main risk factor for stroke patients with migraine. No direct relation between migraine and stroke could be demonstrated.     

The prevalence of patent foramen ovale in patients with migraine

BACKGROUND AND PURPOSE: Migraine is a common neurologic disorder whose etiology remains unknown. Migraine has been reported as a possible risk factor for ischemic stroke, especially in young women. The relationship between migraine and stroke is stronger in patients suffering from migraine with aura compared to those with common migraine. Coexistence of migraine and patent foramen ovale (PFO) should be also considered. The aim of our study was to evaluate the frequency of PFO in patients with migraine with aura (MA) and compare it with the prevalence of PFO in migraine patients without aura (M) and in a healthy age-matched control group. MATERIAL AND METHODS: We assessed 62 patients (48 females) suffering from migraine with aura, 60 without aura (53 females) and 65 normal controls (51 females). In order to detect PFO the contrast transcranial Doppler was performed during Valsalva maneuver. RESULTS: The presence of PFO was found in 33/62 (53%) patients with MA compared to 15/60 (25%) without aura, and in 16/65 (25%) control subjects. The difference in PFO prevalence between MA patients and M patients and the difference between MA patients and the control group was statistically significant (p<0.05). CONCLUSIONS: Our findings suggest that at least some attacks of migraine with aura may be associated with paradoxical embolism.     

Auditory cognitive event-related potentials in migraine with and without aura in children and adolescents

BACKGROUND AND PURPOSE: Cognitive Event-Related Potentials (CERP) reflect sensory information processing: cognitive function and early memory. Studies of CERP in adult migraneurs yielded contradictory results. The aim of our study was to evaluate CERP in children and adolescents with migraine with and without aura during the interictal period. MATERIAL AND METHODS: The study was carried out on 111 children aged 7-18 years (mean 12.92 (2.78) with idiopathic attack headaches. In this group migraine with aura (MA) was diagnosed in 27 patients, migraine without aura (MO) in 36 children and episodic tension-type (TH) headaches in 48 patients. RESULTS: The latencies N2 and P3 were significantly longer (p < 0.05 and p < 0.01, respectively) in the group of all migraneurs (MA + MO, n = 63) as compared with the TH group. In the MO group not only N2 and P3 latency, but also P2 latency (p < 0.05) were longer, if particular types of migraine were compared with tension-type headaches. There were no statistically significant differences between mean latencies in MA and TH groups. Analyzing CERP amplitudes, the N1/P2 amplitude was significantly higher in MO patients than in the TH group only. We found longer P2, N2 and P3 latencies and higher N1/P2 amplitude in MO patients in comparison with MA patients. We found correlation between P3 latency and the age of patients with migraine. There were no statistically significant correlations for either headache type between CERP parameters and illness duration, sex of patients and unilateral localisation of headache. CONCLUSIONS: The CERP parameter changes in children with migraine point out the disturbances of cognitive functions also for auditory modalities. It suggests generalized dysfunction of cortical information processing in the interictal period of migraine.     

Small deep white matter lesions are associated with right-to-left shunts in migraineurs

The right-to-left shunts (RLS) and white matter lesions (WMLs) are frequently observed in migraineurs and in patients with ischemic stroke. Previous studies have reported that the burden of WMLs did not increase with the intracardiac right-to-left shunt (RLS) in migraineurs. However, some types of WMLs are known to be associated with RLS in patients with stroke and dementia. The aim of the study was to demonstrate the difference in the size and location of WMLs, according to the existence of RLS in patients with headache. From the prospective headache registry, a total of 425 subjects (age, 30.8 ± 5.1 years; 303 women; 242 migraineurs; 183 patients with tension-type headache (TTH)) were retrospectively reviewed and evaluated for RLS and WMLs using M-mode power transcranial Doppler sonography (mTCD) and brain magnetic resonance imaging scans. We scored WMLs, according to the Rotterdam Scan Study, and assessed the association between RLS presence and the location and size of WMLs. The number of small deep WMLs (dWMLs) and the prevalence of RLS, defined as microembolic signals (MES) ≥11, were higher in patients with migraine (small dWMLs, 6.23 vs. 4.05; RLS, 36.8% vs. 10.9%), compared to patients with TTH. There was no significant difference in the sum of periventricular WML grades or the total volume of dWMLs between TTH and migraine patients. Among the migraineurs, the patients with RLS more frequently had small dWMLs, aura, and heart disease compared to those without RLS. In addition, RLS were also independent predictors for the presence of small dWMLs from the multivariate binary regression analysis (p < 0.01; OR = 3.24; 95%CI 1.56–6.72). Small dWMLs are associated with RLS in young migraineurs. These results imply that paradoxical embolism may cause the small WMLs in some migraineurs.     

Relationship between non-headache symptoms and right to left shunt in episodic migraine. A single-center cross-sectional study

The relationship between right to left shunt (RLS) and non-headache symptoms (NHS) in episodic migraine is unknown. This study aimed to investigate the incidence and classification of RLS in episodic migraineurs, calculate the occurrence rate of NHS, and analyze the associations between RLS and NHS. We consecutively recruited 204 episodic migraine patients. Contrast-enhanced transcranial doppler was adopted to screen RLS. Structured questionnaire via face-to-face survey was conducted to collect clinical data. A total of 172 episodic migraineurs were included in the final analysis, of which 20 cases were migraine with aura. The positive rate of RLS was 47.1%, of which 50 cases (29.0%) had small shunt (Grade 1) and 31 cases (18.1%) had mid-large shunt (Grade 2–4). The most common NHS was nausea (115 (66.9%)), followed by headache aggravation with physical activity (96 (55.8%)), dizziness (93 (54.1%)), vomiting (77 (44.8%)) and phonophobia (74 (43.0%)). Yawning was more common in Grade 2–4 group than Grade 0 group (p = 0.012), while no statistical differences among other groups. Grade 2–4 group had a higher rate of headache aggravation with physical activity than grade 0 group (p = 0.008). Binary logistic regression analysis showed that yawning at premonitory phase, headache aggravation with physical activity and cranial autonomic symptoms during attack are independent predictors of RLS. In conclusion, yawning and headache aggravation with physical activity are more common in migraine patients with RLS. Besides aura, particular NHS may also serve as indicators for screening RLS in episodic migraineurs.     

应用M-模经颅多普勒超声技术评价头痛与卵圆孔未闭的关系

目的观察头痛、有先兆偏头痛(MA)、无先兆偏头痛(MO)患者卵圆孔未闭(PFO)的发生率,以及较大分流的发生率。方法头痛患者268例,其中MA组59例,MO组158例,其他类型头痛组51例,健康对照组75例。以肘前静脉注射激活的生理盐水作为造影剂,并结合Valsava动作,行M-模经颅多普勒超声(mpTCD)监测,诊断PFO并对分流量进行分级。安静状态时出现阳性结果则判断为永久型分流,Valsava动作后出现阳性结果则判断为功能型分流。注射生理盐水后20 s内微栓子信号超过30个判断为大量分流。结果全部头痛患者中PFO的发生率为44%,其中永久型分流53例,功能型分流43例。MA组存在分流的患者数显著多于对照组(P<0.001),也多于其他头痛组(P<0.01)。MO组存在分流的患者数高于对照组及其他头痛组,但未获得统计学差别(分别为P=0.054和P=0.3)。较大分流量在MA组、MO组、其他头痛组和对照组的发生率分别为37%、15%、8%、4%,MA组、MO组均显著高于对照组(分别为P<0.01和P<0.05)。结论有先兆偏头痛组患者存在较多PFO,而且偏头痛组较大分流量的患者较多。     

Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study.

BACKGROUND: The recently found association between patent foramen ovale (PFO) and transient global amnesia (TGA) has suggested that paradoxical microembolization in the terminal vertebrobasilar territory might underlie at least some TGA cases. Migraine with visual aura is another paroxysmal disturbance in which a sudden dysfunction of cortical areas fed by the terminal branches of the basilar artery is believed to trigger the attack. Therefore we investigated the prevalence of PFO in a consecutive unselected cohort of migraine patients. OBJECTIVE: To investigate the prevalence of PFO in a consecutive unselected cohort of migraine patients to search for a possible mechanism for the reported association of migraine with stroke. METHODS AND RESULTS: A total of 113 patients, consecutively referred by the Headache Outpatient Clinic for migraine with aura (MA+, mean age 34+/-12 years) were compared with 53 patients with migraine without aura (MA-, mean age 36+/-13 years) and with 25 age-matched nonmigraine subjects (mean age 31+/-10 years) selected from the hospital staff. PFO was assessed with transcranial Doppler sonography with IV injection of agitated saline, a technique that is 90% sensitive and 100% specific. The prevalence of PFO was 48% (54/113) in MA+ patients, 23% (12/53) in MA- patients, and 20% (5/25) in control subjects. The difference between MA+ and MA- patients was significant (odds ratio [OR] = 3.13, 95% confidence interval [CI] = 1.41 to 7.04, chi2 = 9.52,p = 0.002) as was the difference between MA+ patients and controls (OR = 3.66, 95% CI = 1.21 to 13.25, chi2 = 6.46, p = 0.01), whereas MA- patients did not differ from controls (OR = 1.17, 95% CI = 0.32 to 4.45, chi2 = 0.07). MRI was negative in 22 MA+ and 8 MA- patients. CONCLUSIONS: Patency of the foramen ovale is associated with migraine with aura but not with migraine without aura. The increased risk of stroke found in epidemiologic studies in patients with migraine with aura may be explained by an increased propensity to paradoxical cerebral embolism.