In patients with cryptogenic stroke who have migraine, there is a high prevalence (79%) of patent foramen ovale (PFO) with right-to-left shunt, according to a recent study. Furthermore, the timing of the stroke in migraineurs is usually not related to a migraine attack. Patients between the ages of 18 and 60 who presented with an ischemic stroke were characterized based on ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other causes, dissection) phenotyping. A migraine diagnosis was identified by reviewing physician notes, and frequent aura was defined if present in at least 50% of attacks. A PFO with right-to-left shunt diagnosis was identified by the presence of a positive bubble contrast study. Researchers found:
- Of the 712 patients who presented with ischemic stroke, 127 (18%) were diagnosed as cryptogenic; 68 patients had adequate testing for PFO and a documented migraine history.
- The prevalence of PFO in patients with cryptogenic stroke without migraine was elevated (59%) compared with the general population (18%).
- Patients with both cryptogenic stroke and migraine had a higher prevalence of PFO (79%).
In patients with cryptogenic stroke who had migraine with frequent aura, the prevalence of PFO was 93%.
Frequency of patent foramen ovale and migraine in patients with cryptogenic stroke. [Published online ahead of print April 10, 2018]. Stroke. doi:10.1161/STROKEAHA.117.020160.