“I think that’s why MIST failed, because we were taking all-comers. “Until we can predict which patients are going to benefit from closure, it’s very hard to set up a trial where we are isolating migraines as a sole endpoint,” said Dr. But several factors could explain this finding, the physicians commented. Muddying the waters regarding the link between PFO and migraine is the MIST (Migraine Intervention with STARFlex Technology) trial, which did not reveal a benefit to PFO closure for migraine sufferers. But migraines tend to be very stereotypic.” If it were a particle, it would land randomly so you’d have a a stroke that would be very different each time. “That is, the patient usually has the headache on the same side, and they have an aura of the same type. “The migraine is very typical,” he told TCTMD in a telephone interview. Tobis believes the trigger is more likely to be a chemical than a particle, though the mechanism whereby the chemical passes through the shunt and lands in a vulnerable area of the brain would be the same. It also explains why, in a number of patients with migraines, antiplatelet therapy can also reduce these patients’ headaches.”įor his part, Dr. “That would explain why closing the holes in some patients, for whom microembolization is the trigger, would potentially treat their headaches. “Perhaps patients who are capable of having embolic material cross from the right side to the left side through the PFO could have microembolization cross through without being large enough to cause strokes,” he said. Sommer, MD, of Columbia University Medical Center (New York, NY), explained why PFOs might be linked to migraines in the first place. In a telephone interview with TCTMD, Robert J. Eighty patients (36%) underwent PFO closure, which resolved aura and/or migraine headache in most patients after 12 months irrespective of aura category ( P = NS table 1). Together, all patients who experienced aura had much higher rates of shunting than controls (18% P < 0.0001). The frequency of shunting was highest among patients who experienced aura plus migraine and similar for those who experienced aura unrelated to migraine or without migraine. Controls had neither migraine headache nor aura. The investigators next compared the frequency of right-to-left shunt on transcranial Doppler among the 3 groups, which were compared with a control group of 200 patients referred to the cardiac cath lab for diagnostic catheterization unrelated to PFO. Aura unrelated in time to migraine headache (n = 29).Aura associated with migraine headache (n = 175).Participants were divided into 3 groups according to the occurrence of: ![]() Tobis, MD, and colleagues identified 225 who experienced visual aura with or without migraine headache. The study also suggests that closing the PFO will produce symptom relief, a finding that could be confirmed upon completion of an ongoing clinical trial.Īmong patients referred to the University of California, Los Angeles (Los Angeles, CA) for suspected PFO, Jonathan M. Download this article's Factoid in PDF (& PPT for Gold Subscribers)Īuras experienced by patients with patent foramen ovale (PFO) likely have similar etiologies whether or not they occur in patients who also experience migraine headaches, according to research published in the June 2012 issue of JACC: Cardiovascular Interventions.
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