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From the Departments of Cardiology (Drs. Schwerzmann, Lagger, Windecker, Meier, and Seiler) and Neurology (Drs. Nedeltchev and Mattle), University Hospital, Inselspital, Bern, Switzerland.
Address correspondence and reprint requests to Dr. Christian Seiler or Dr. Markus Schwerzmann, Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital Inselspital, CH-3010 Bern, Switzerland; e-mail: christian.seiler{at}insel.ch or markus.schwerzmann{at}insel.ch
Background: Transcranial contrast Doppler studies have shown an increased prevalence of right-to-left shunts in patients with migraine with aura compared with controls. The anatomy and size of these right-to-left shunts have never been directly assessed.
Methods: In a cross-sectional case-control study, the authors performed transesophageal contrast echocardiography in 93 consecutive patients with migraine with aura and 93 healthy controls.
Results: A patent foramen ovale was present in 44 (47% [95% CI 37 to 58%]) patients with migraine with aura and 16 (17% [95% CI 10 to 26%]) control subjects (OR 4.56 [95% CI 1.97 to 10.57]; p < 0.001). A small shunt was equally prevalent in migraineurs (10% [95% CI 5 to 18%]) and controls (10% [95% CI 5 to 18%]), but a moderate-sized or large shunt was found more often in the migraine group (38% [95% CI 28 to 48%] vs 8% [95% CI 2 to 13%] in controls; p < 0.001). The presence of more than a small shunt increased the odds of having migraine with aura 7.78-fold (95% CI 2.53 to 29.30; p < 0.001). Besides patent foramen ovale prevalence and shunt size, no other echocardiographic differences were found between the study groups. Headache and baseline characteristics did not differ in migraine patients with and without shunt.
Conclusions: Nearly half of all patients with migraine with aura have a right-to-left shunt due to a patent foramen ovale. Shunt size is larger in migraineurs than controls. The clinical presentation of migraine is identical in patients with and without a patent foramen ovale.
This article was previously published in electronic format as an Expedited E-Pub on September 7, 2005, at www.neurology.org.
Supported by the Swiss Heart Foundation (to M.S. and C.S.).
Disclosure: The authors report no conflicts of interest.
Received June 8, 2005. Accepted in final form July 21, 2005.
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