Slide 1: Which of the following conditions may be associated with a higher risk of patent foramen ovale? A) Migraine with aura. B) Epilepsy. C) Tourette’s syndrome. D) Parkinson’s disease.

Slide 2: A) Migraine with aura. Conflicting data exist regarding the association between PFO and migraine with aura. While the largest cross-sectional study to date found no association, a 2008 meta-analysis supported the linkage.

Slide 3: In addition to PFO, there are apparent associations between migraine and other conditions that results in right to left shunting, such as Hereditary Hemorrhagic Telangiectasia (HHT). In HHT, patients form intrapulmonary shunts due to AVMs in their lungs. Theoretically, in both conditions, vasoactive substances that are normally deactivated in lung capillaries may enter the cerebral circulation and contribute to the development of migraines.

References

  • Rundek T, Elkind MS, Di Tullio MR, et al. Patent foramen ovale and migraine: a cross-sectional study from the Northern Manhattan Study (NOMAS). Circulation. 2008 Sep 30;118(14):1419-24. Epub 2008 Sep 15. PMID 18794393
  • Schwedt TJ, Demaerschalk BM, Dodick DW. Patent foramen ovale and migraine: a quantitative systematic review. Cephalalgia. 2008 May;28(5):531-40. Epub 2008 Mar 17. PMID 18355348
  • Cutrer FM, Bajwa ZH. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. UpToDate.
  • Elphick A1, Shovlin CL. Relationships between epistaxis, migraines, and triggers in hereditary hemorrhagic telangiectasia. Laryngoscope. 2014 Jul;124(7):1521-8. Epub 2014 Jan 23. PMID 24458873
Tags: , , ,