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Dr. Kifah K. Al- Ubaidy*, Dr. Aqeel R. Hassan and Dr. RadhiF. Shlash


Background: Several studies have reported a significantly higher incidence of patent foramen ovale (PFO) in patients with migraine with aura. Furthermore; several publications reported a consistent improvement of migraine symptoms following PFO closure. Some authors have emphasized a high concentration of vasoactive agents shunted to left circulation by PFO will trigger migraine attacks. The shunting of vasoactive agents to the left circulation eventually has its influence on autonomic function. Aim: Study the autonomic changes in migraineur during ictal phase to verify whether PFO triggering migraine attacks. Methods: The study included 112 patients, satisfying the International Headache Society criteria-2 for primary episodic migraine, within age group of 20 to 40 years of either sex. All patients underwent transthoracic Echocardiography. The autonomic function test (Expiratory-inspiratory (E: I ratio), Standing to Lying Ratio (S/L Ratio), 30: 15 ratio, Valsalva ratio and hand Grip Test) was performed in the neurology department under standardized laboratory conditions. Results: From 112 migraine patients, 34 (30.4%) patients having PFO (MPFO) and 78 (69.6%) not having PFO (MN). Megrainers with aura were 28/112 (25%), MPFO having aura 18/34 (52.9%) Vs. 10/78 (12.8%) MN patients, aura is significantly higher in MPFO P value <0.05. The mean values for E: I ratio, S/L Ratio, 30: 15 ratio, Valsalva ratio and hand Grip Test diastolic blood pressure are 1.17, 1.18, 1.19 , 1.32 , 9.4 mmHg respectively in MPFO compared to 1.43, 1.35 , 1.23, 1.41, 15.8 mmHg in MN respectively. All previous tests are significantly impaired in MPFO P value < 0.05. The study showed that patients with MPFO had significant higher association with aura and markedly impaired AFT during the ictal stage compared to MN. Conclusion: Patients with MPFO have more aura incidence and markedly deranged autonomic function; accordingly we can suggest that PFO is a trigger factor for migraine or making migrainers more vulnerable to external triggers and results seem to suggest that PFO and aura have causal relation rather than comorbid association. The results affirm the role of PFO in the pathophysiology of migraine trigger.

Keywords: PFO, migraine, aura, autonomic changes.

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