New Article: Prevalence and size of directly detected … uery_hl=10

Prevalence and size of directly detected patent foramen ovale in migraine with aura.

Schwerzmann M, Nedeltchev K, Lagger F, Mattle HP, Windecker S, Meier B, Seiler C.

From the Departments of Cardiology (Drs. Schwerzmann, Lagger, Windecker, Meier, and Seiler) and Neurology (Drs. Nedeltchev and Mattle), University Hospital, Inselspital, Bern, Switzerland.

Abstract-- 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.

I don’t understand what this article means. Any ideas?


Hi Linda

Good question. I just realised the article is very vague and doesn’t mention the key word - heart.

They are talking about a right-to-left shunt known as a “patent foramen ovale” which is a birth defect
where there is a small hole between the left and right ventricle of the heart. Deoxygenated blood manages
to travel into the left ventricle and hence into the brain, without being filtered first. There are thoughts
that this is the cause of many strokes, and the presence of this birth defect is very, very common
in those with migraine.


Oh Adam, Thanks I didn’t get that from the article. Thats very interesting. I am sure one day this will all be figured out. I don’t expect I will be around when that happens but will be good for others.