Right-to-left shunt (RLS), usually due to patent foramen ovale, is a well-established risk factor for ischemic stroke in young patients, while the role of migraine as an independent factor is still debated. We evaluated 44 patients suffering from migraine with aura, and compared them with 73 patients younger than 50 with focal cerebral ischemia, and 50 controls, asymptomatic for cerebrovascular disease, and without a history of migraine. All the subjects underwent bilateral transcranial Doppler with injection of contrast medium in an antecubital vein. The test was performed during normal ventilation and during Valsalva maneuver, recording both the middle cerebral arteries and the basilar artery. Criteria for diagnosing RLS was the presence of at least 3 microbubbles within 15 s from injection. Eighteen out of 44 migraine patients (41%) showed RLS, as opposed to 8 of 50 controls (16%) (p < 0.005). Twenty-six out of 73 patients with cerebral ischemia had RLS (35%). We conclude that the prevalence of RLS in patients with migraine with aura is significantly higher than in normal controls, and is similar to the prevalence of RLS in young patients with stroke. These findings could be helpful in understanding the relationship between migraine and stroke.

Keywords:
Migraine, Transcranial Doppler, Right-to-left shunt, Patent foramen ovale, Cerebral ischemia, focal
1.
Webster MW, Chancellor AM, Smith HJ, Swift DL, Sharpe DN, Bass NM, Glasgow GL: Patent foramen ovale in young stroke patients. Lancet 1988;ii:11–12.
2.
Lechat P, Mass JL, Lescault G, Loron P, Theard M, Klimczac M, Drobinski G, Thomas D, Grosgogeat Y: Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988;318:1148–1152.
3.
Di Tullio M, Sacco RL, Aasha G, Mohr JP, Shunichi H: Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med 1992;117:461–465.
4.
Cabanes L, Mass JL, Choen A, Amarenco P, Cabanes PA, Oubary P, Chedru F, Guérin F, Bousser M-G, de Recondo J: Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography. Stroke 1993;24:1865–1873.
5.
Chimowitz MI, Nemec JJ, Marwick TH, Loring RJ, Furlan AJ, Salcedo EE: Transcranial Doppler ultrasound identifies patients with right-to-left cardiac or pulmonary shunts. Neurology 1991;41:1902–1904.
6.
Di Tullio M, Sacco RL, Venketasubramanian N, Sherman D, Mohr JP, Shunichi H: Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke 1993;24:1020–1024.
7.
Jauss M, Kaps M, Keberle M, Haberbosch W, Dorndorf W: A comparison of transesophageal echocardiography and transcranial Doppler sonography with contrast medium for detection of patent foramen ovale. Stroke 1994;25:1265–1267.
8.
Anzola GP, Renaldini E, Magoni M, Costa A, Cobelli M, Guindani M: Validation of transcranial Doppler sonography in the assessment of patent foramen ovale. Cerebrovasc Dis 1995;5:194–198.
9.
Schminke U, Ries S, Daffershofer M, Staedt U, Hennerici M: Patent foramen ovale: A potential source of cerebral embolism? Cerebrovasc Dis 1995;5:133–138.
10.
Zanette EM, Mancini G, De Castro S, Solaro M, Cartoni D, Chiarotti F: Patent foramen ovale and transcranial Doppler. Comparison of different procedures. Stroke 1996;27:2251–2255.
11.
Marini C, Carolei A, Robers RS, Prencipe M, Gandolfo C, Inzitari D, Landi G, De Zanche L, Scoditti U, Fieschi C, and the National Research Council Study Group: Focal cerebral ischemia in young adults: A collaborative case-control study. Neuroepidemiology 1993;12:70–81.
12.
Tzourio C, Iglesias S, Huber J-B, Visy J-M, Alpérovitch A, Tehindrazanarivelo A, Biousse V, Woimant F, Bousser M-G: Migraine and risk of ischemic stroke: A case-control study. BMJ 1993;307:289–292.
13.
Carolei A, Marini C, De Matteis G, and the Italian National Research Council Study Group on Stroke in the Young: History of migraine and risk of cerebral ischemia in young adults. Lancet 1996;347:1503–1506.
14.
Hoekstra-van Dalen RAH, Cillessen JPM, Kappelle LJ, van Gijn J: Cerebral infarcts associated with migraine: Clinical features, risk factors and follow-up. J Neurol 1996;243:511–515.
15.
Tzourio C, Tehindrazanarivelo A, Iglésias S, Alpérovitch A, Chedru F, d’Anglejan-Chatillon J, Bousser MG: Case-control study of migraine and risk of ischaemic stroke in young women. BMJ 1995;310:830–833.
16.
Merikangas KR, Fenton BT, Cheng SH, Stolar MJ, Risch N: Association between migraine and stroke in a large-scale epidemiological study of the United States. Arch Neurol 1997;54:362–368.
17.
Ries S, Steinke W, Schindlmayr C, Meairs S, Hennerici M: Ischemia-induced migraine from paradoxical cardioembolic stroke. Eur Neurol 1996;36:76–78.
18.
Headache Classification Committee of International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 1988;8:27.
19.
Pfaffenrath V, Pollman W, Autenrieth G, Rosmanith U: Mitral valve prolapse and platelet aggregation in patients with hemiplegic and non-hemiplegic migraine. Acta Neurol Scand 1987;75:253–257.
20.
D’Andrea G, Cananzi AR, Perini F, Hasselmark L: Platelets models and their possible usefulness in the study of migraine pathogenesis. Cephalalgia 1995;15:265–271.
21.
Welch KMA: Relationship between stroke and migraine. Neurology 1994;44(suppl 7):S33–S36.
22.
Henrich JB, Sandercock PAG, Warlow CP, Jones LN: Stroke and migraine in the Oxfordshire Community Stroke Project. J Neurol 1986;233:257–262.
23.
Bogousslavsky J, Regli F, Van Melle G, Payot M, Uske A: Migraine stroke. Neurology 1988;38:223–227.
24.
Rothrock J, North J, Madden K, Lyden P, Fleck P, Dittrich H: Migraine and migrainous stroke: Risk factors and prognosis. Neurology 1993;43:2473–2476.
25.
Silvestrini M, Matteis M, Troisi E, Cupini LM, Zaccari G, Bernardi G: Migrainous stroke and antiphospolipid antobodies. Eur Neurol 1994;34:316–319.
26.
Klötzsch C, Sliwka U, Berlit P, Noth J: An increased frequency of patent foramen ovale in patients with transient global amnesia. Analysis of 53 consecutive patients. Arch Neurol 1996;53:504–508.
27.
Caplan L, Chedru F, Lhermitte F, Mayman C: Transient global amnesia and migraine. Neurology 1981;31:1167–1170.
28.
Hodges JR, Warlow CP: The etiology of transient global amnesia: a case-control study of 114 cases with prospective follow-up. Brain 1990;113:639–657.
29.
Crowell GF, Stump DA, Biller J, McHenry LC, Toole JF: The transient global amnesia-migraine connection. Arch Neurol 1984;41:75–79.
30.
Klotzsch C, Janssen G, Berlit P: Transesophageal echocardiography and contrast-TCD in the detection of a patent foramen ovale: Experiences with 111 patients. Neurology 1994;44:1603–1606.
1998
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