Prevalence of Cardiac Shunt Lesions in patients with Migraine with Aura and without Aura.

Elangovan, S (2008) Prevalence of Cardiac Shunt Lesions in patients with Migraine with Aura and without Aura. Masters thesis, Stanley Medical College, Chennai.


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Migraine headache is a common disabling condition which represents a significant healthcare burden. It is characterised by recurrent disabling attacks of headache associated with nausea, vomiting, hypersenstivity to light, sound, and smell and in a third of patients neurological aura symptoms. These aura symptoms are fully reversible visual, sensory or speech disturbances. Visual disturbances are common and last for 5 – 60 mins. The underlying neurological mechanism for aura is cortical spreading depression. Recent evidence found a significant association between patent foramen ovale and transient global amnesia. This finding prompted the suggestion that paradoxical microembolisation in the vertebrobasilar territory may cause transient global amnesia. Like transient global amnesia, migraine with visual aura is a 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. Arteriovenous shunting of vasoactive substances from the venous to the arterial system through a patent foramen ovale in patents with migraine may affect endothelial function (van mokt et al.). In individuals with a right to left shunt, a lower dose of venous trigger substances may be needed to induce migraine because the shunt permits the pulmonary filter to be bypassed. Many studies have shown migraineurs who experience an aura are more likely to have a patent foramen ovale (48%) than the general population (20%). Right to left cardiac shunt at rest through a patent foramen ovale (PFO) is more common in migraineurs with aura (15%) than in control patients with patent foramen ovale who do not experience migraine (0%). This suggest that interatrial communication may play a role in the pathogenesis of migraines. Closure of patent foramen ovale had resolved symptoms of migraine with aura in 50% of patients and improved symptoms in other 50% of subjects. Many studies have demonstrated closure of patent foramen ovale reduce migraine symptoms . This study investigated the prevalence of cardiac shunt lesions in migraine patients with and without aura. The transesophageal contrast echocardiography has been done to detect intracardiac shunts in migraine patients with and without aura. AIMS AND OBJECTIVES : 1. To evaluate the frequency of cardiac shunt lesions in patients with migraine with aura and migraine without aura. 2. To correlate the variables of migraine with variables of shunt. 3. To compare the results of our study with that reported by other studies performed in various parts of the world. CONCLUSION : 1. The female to male ratio in our study was found to be 2.8:1.Female predilection was more in younger age group <35 years. 2. Shunt lesion was present in 34% of migraine with aura patients. But only in 5% of migraine without aura patients. 3. Osteum secundum type of atrial septal defect was found to be the mo st common shunt lesion in our 24% of migraine with aura patients. 4. Patent foramen ovale was found in 10% of migraine with aura patients. 5. Atrial septal defect of svc type was noticed in only 5% of migraine without aura patients. 6. Statistically significant number of migraine with aura patients had shunt lesions. 7. Transesophageal contrast echocardiography is valuable in patients with migraine more so in aura patients to detect shunt lesions. 8. Closure of the shunt in patients with migraine may ameliorate symptoms.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prevalence of Cardiac Shunt Lesions ; patients ; Migraine ; Aura and without Aura.
Subjects: MEDICAL > Neurology
Depositing User: Kambaraman B
Date Deposited: 30 Jun 2017 02:54
Last Modified: 30 Jun 2017 05:56

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