Patent foramen ovale in trigeminal autonomic cephalalgias and hemicrania continua: a non-specific pathophysiological occurrence?

Patent foramen ovale (PFO), a relatively common abnormality in adults, has been associated with migraine. Few studies also linked PFO with cluster headache (CH). To verify whether right-to-left shunt (RLS) is related to headaches other than migraine and CH, we used transcranial Doppler following microbubbles injection to detect shunts in 24 CH, 7 paroxysmal hemicrania (PH), one SUNCT, two hemicrania continua (HC) patients; and 34 matched controls. RLS was significantly more frequent in CH than in controls (54% vs. 25%, p=0.03), particularly above the age of 50. In the HC+PH+SUNCT group, RLS was found in 6 patients and in 2 controls (p=0.08). Smoking as well as the Epworth Sleepiness Scale correlated significantly with CH, smoking being more frequent in patients with RLS. PFO may be non-specifically related to trigeminal autonomic cephalalgias and HC. The headache phenotype in PFO patients probably depends on individual susceptibility to circulating trigger factors.

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Unilateral Photophobia or Phonophobia in Migraine Compared With Trigeminal Autonomic Cephalalgias

Cephalalgia ◽

10.1111/j.1468-2982.2008.01565.x ◽

2008 ◽

Vol 28 (6) ◽

pp. 626-630 ◽

Cited By ~ 69

Author(s):

P Irimia ◽

E Cittadini ◽

K Paemeleire ◽

AS Cohen ◽

PJ Goadsby

Keyword(s):

Cluster Headache ◽

Clinical Symptoms ◽

Medication Overuse Headache ◽

Episodic Migraine ◽

Chronic Cluster Headache ◽

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Primary Headaches ◽

Trigeminal Autonomic Cephalalgias ◽

A Prospective Study

Our objective was to compare the presence of self-reported unilateral photophobia or phonophobia, or both, during headache attacks comparing patients with trigeminal autonomic cephalalgias (TACs)—including cluster headache, shortlasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and paroxysmal hemicrania—or hemicrania continua, and other headache types. We conducted a prospective study in patients attending a referral out-patient clinic over 5 months and those admitted for an intramuscular indomethacin test. Two hundred and six patients were included. In episodic migraine patients, two of 54 (4%) reported unilateral photophobia or phonophobia, or both. In chronic migraine patients, six of 48 (13%) complained of unilateral photophobia or phonophobia, or both, whereas none of the 24 patients with medication-overuse headache reported these unilateral symptoms, although these patients all had clinical symptoms suggesting the diagnosis of migraine. Only three of 22 patients (14%) suffering from new daily persistent headache (NDPH) experienced unilateral photophobia or phonophobia. In chronic cluster headache 10 of 21 patients (48%) had unilateral photophobia or phonophobia, or both, and this symptom appeared in four of five patients (80%) with episodic cluster headache. Unilateral photophobia or phonophobia, or both, were reported by six of 11 patients (55%) with hemicrania continua, five of nine (56%) with SUNCT, and four of six (67%) with chronic paroxysmal hemicrania. Unilateral phonophobia or photophobia, or both, are more frequent in TACs and hemicrania continua than in migraine and NDPH. The presence of these unilateral symptoms may be clinically useful in the differential diagnosis of primary headaches.

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Aura in trigeminal autonomic cephalalgia is probably mediated by comorbid migraine with aura

Cephalalgia ◽

10.1177/03331024211030499 ◽

2021 ◽

pp. 033310242110304

Author(s):

Kuan-Po Peng ◽

Marlene Schellong ◽

Arne May

Keyword(s):

Cluster Headache ◽

Migraine With Aura ◽

Migraine Without Aura ◽

Telephone Interview ◽

Medical Center ◽

Temporal Correlation ◽

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Trigeminal Autonomic Cephalalgias ◽

Trigeminal Autonomic Cephalalgia

Objective The presence of aura is rare in cluster headache, and even rarer in other trigeminal autonomic cephalalgias. We hypothesized that the presence of aura in patients with trigeminal autonomic cephalalgias is frequently an epiphenomenon and mediated by comorbid migraine with aura. Methods The study retrospectively reviewed 480 patients with trigeminal autonomic cephalalgia in a tertiary medical center for 10 years. Phenotypes and temporal correlation of aura with headache were analyzed. Trigeminal autonomic cephalalgia patients with aura were further followed up in a structured telephone interview. Results Seventeen patients with aura (3.5%) were identified from 480 patients with trigeminal autonomic cephalalgia, including nine with cluster headache, one with paroxysmal hemicrania, three with hemicrania continua, and four with probable trigeminal autonomic cephalalgia. Compared to trigeminal autonomic cephalalgia patients without aura, trigeminal autonomic cephalalgia patients with aura were more likely to have a concomitant diagnosis of migraine with aura (odds ratio [OR] = 109.0, 95% CI 30.9–383.0, p < 0.001); whereas the risk of migraine without aura remains similar between both groups (OR = 1.10, 95% CI = 0.14–8.59, p = 0.931). Aura was more frequently accompanied with migraine-like attacks, but not trigeminal autonomic cephalalgia attacks. Interpretation In most patients with trigeminal autonomic cephalalgia, the presence of aura is mediated by the comorbidity of migraine with aura. Aura directly related to trigeminal autonomic cephalalgia attack may exist but remains rare. Our results suggest that aura may not be involved in the pathophysiology of trigeminal autonomic cephalalgia.

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Concomitant occurrence of different trigeminal autonomic cephalalgias: A case series and review of the literature

Cephalalgia ◽

10.1177/0333102413506127 ◽

2013 ◽

Vol 34 (3) ◽

pp. 231-235 ◽

Cited By ~ 10

Author(s):

Andreas Totzeck ◽

Hans-Christoph Diener ◽

Charly Gaul

Keyword(s):

Cluster Headache ◽

Clinical Presentation ◽

Case Series ◽

Primary Headache ◽

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Trigeminal Autonomic Cephalalgias ◽

Headache Disorders ◽

Primary Headache Disorders

Introduction The trigeminal autonomic cephalalgias (TACs) subsume four primary headache disorders. Hemicrania continua is increasingly regarded as an additional TAC. In rare cases patients may present with two different TACs or a TAC and hemicrania continua. Cases We report four patients with two different TACs or one TAC and hemicrania continua. Two patients presented with cluster headache and paroxysmal hemicrania, one patient with cluster headache and hemicrania continua, and one patient suffered from cluster headache and SUNCT. Discussion While the International Classification of Headache Disorders (ICHD-II) proposes specific diagnostic criteria, the variability of clinical presentation may make clear diagnosis difficult. All patients fulfilled the ICHD-II criteria. The manifestation of two different TACs or hemicrania continua in one patient is uncommon but possible and should be taken into account especially when chronic headache patients present with changing headache symptoms.

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A comparison of transcranial Doppler, transthoracic echocardiography, and transesophageal echocardiography in the diagnosis of patent foramen ovale

Human Health and Medical Engineering ◽

10.2495/hhme130141 ◽

2014 ◽

Author(s):

Zi-Ming Yan ◽

Ying-Qi Xing ◽

Xiu-Juan Wu ◽

Kang-ding Liu

Keyword(s):

Transesophageal Echocardiography ◽

Transcranial Doppler ◽

Transthoracic Echocardiography ◽

Patent Foramen Ovale ◽

Foramen Ovale

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Prevalence of patent foramen ovale in a large series of patients with migraine with aura, migraine without aura and cluster headache, and relationship with clinical phenotype

The Journal of Headache and Pain ◽

10.1007/s10194-005-0223-9 ◽

2005 ◽

Vol 6 (4) ◽

pp. 328-330 ◽

Cited By ~ 80

Author(s):

G. Dalla Volta ◽

M. Guindani ◽

P. Zavarise ◽

S. Griffini ◽

A. Pezzini ◽

...

Keyword(s):

Cluster Headache ◽

Migraine With Aura ◽

Patent Foramen Ovale ◽

Migraine Without Aura ◽

Clinical Phenotype ◽

Large Series ◽

Foramen Ovale

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Cervical carotid artery may be the most dependable alternative place for detection of patent foramen ovale with contrast transcranial doppler in the patients with insufficient temporal sonic bone window

Journal of the Neurological Sciences ◽

10.1016/j.jns.2009.05.008 ◽

2009 ◽

Vol 284 (1-2) ◽

pp. 225-226 ◽

Cited By ~ 1

Author(s):

Mehmet A. Topcuoglu

Keyword(s):

Carotid Artery ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Foramen Ovale ◽

Bone Window

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Is Migraine Associated with Right-to-Left Shunt a Separate Disease? Results of the SAM Study

Cephalalgia ◽

10.1111/j.1468-2982.2008.01539.x ◽

2008 ◽

Vol 28 (4) ◽

pp. 360-366 ◽

Cited By ~ 24

Author(s):

GP Anzola ◽

G Meneghetti ◽

C Zanferrari ◽

A Adami ◽

L Dinia ◽

...

Keyword(s):

Family History ◽

Observational Study ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Genetic Linkage ◽

Personal History ◽

Coagulation Disorders ◽

Foramen Ovale ◽

History Of ◽

Pfo Closure

Migraine with aura (MA) is associated with the persistence of patent foramen ovale (PFO) in about 50% of cases, and migraineurs tend to have larger shunts than controls, suggesting that right-to-left shunt (RILES) determined by PFO could play a role in triggering migraine attacks. Moreover, some preliminary reports have suggested that PFO closure may give relief to both migraine and aura attacks. The aim of this study was to clarify if shunt-associated migraine (SAM) has clinical features that allow a distinction from shunt-unrelated migraine (SUM), in a prospective, multicentre, observational study (SAM study). We enrolled consecutive MA patients, who underwent a structured, standardized questionnaire for family and personal history and for detailed migraine features. All were systematically screened for RILES with transcranial Doppler, and for coagulation disorders. Overall, 460 patients were included; the SUM and SAM classes comprised 58% and 42% of patients, respectively. SAM patients were significantly younger (34.1 ± 10 vs. 37.1 ± 11 years), had a more frequent family history of migraine (76% vs. 66%) and a higher frequency of sensory symptoms of aura (51% vs. 41%); by contrast, there was a lesser association of SAM with other cardiac abnormalities and with coagulation disorders. The SAM study suggests that the effect of RILES on migraine features is not relevant. The higher family history of migraine in SAM suggests a possible genetic linkage between migraine and RILES.

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Transcranial Doppler for patent foramen ovale screening: is there a good correlation with transesophageal echocardiography?

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000600001 ◽

2008 ◽

Vol 66 (4) ◽

pp. 785-789 ◽

Cited By ~ 10

Author(s):

Marcos Christiano Lange ◽

Viviane Flumignan Zétola ◽

Admar Moraes de Souza ◽

Élcio Juliato Piovesan ◽

Juliano André Muzzio ◽

...

Keyword(s):

Positive Predictive Value ◽

Transcranial Doppler ◽

Predictive Value ◽

Screening Test ◽

Patent Foramen Ovale ◽

Foramen Ovale ◽

Negative Results ◽

Contrast Enhanced ◽

Group 2 ◽

Group 1

Right-to-left shunt (RLS) can be identified by contrast-enhanced transcranial Doppler (cTCD) in patent foramen ovale (PFO) patients. AIM: To evaluate cTCD for PFO screening comparing it to cTEE. METHOD: 45 previous cTCD performed for PFO diagnosis and correlated its findings with cTEE. Patients were submitted to a cTCD standardized technique and were divided in two groups according to RLS: Group 1, patients with a positive RLS and Group 2 when RLS was negative. RESULTS: 29 (65%) patients were included in group 1 and 16 (35%) in group 2. PFO confirmation by cTEE was performed in 28 (62%) patients. cTCD had a 92.85% sensitivity, 82.35% specificity, 89.65% positive predictive value and 87.5% negative predictive value when compared to cTEE for PFO diagnosis. CONCLUSION: Standardized technique cTCD allows for RLS visualization in PFO patients with a good correlation with cTEE and can be used as a screening test before cTEE.

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Abstract 204: Transcranial Doppler Versus Transthoracic Echocardiography for the Detection of Patent Foramen Ovale in Patients With Cryptogenic Cerebral Ischemia: A Systematic Review and Diagnostic Test Accuracy Meta-analysis

Stroke ◽

10.1161/str.47.suppl_1.204 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Georgios Tsivgoulis ◽

Aristeidis H Katsanos ◽

Theodora Psaltopoulou ◽

Theodoros Sergentanis ◽

Alexandra Frogoudaki ◽

...

Keyword(s):

Cerebral Ischemia ◽

Sensitivity And Specificity ◽

Transcranial Doppler ◽

Transthoracic Echocardiography ◽

Patent Foramen Ovale ◽

Diagnostic Yield ◽

Positive Likelihood Ratio ◽

Receiver Operating Curve ◽

Test Accuracy ◽

Foramen Ovale

Background & Purpose: Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic cerebral ischemia has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach. Methods: We performed a systematic literature review according to PRISMA guidelines to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD or both compared to the gold standard of TEE. Results: Our literature search identified 35 eligible studies including 3067 patients. The summary sensitivity and specificity for TCD was 96.1% (95% confidence interval: 93.0%-97.8%) and 92.4% (95%CI: 85.5%-96.1%), whereas the respective measures for TTE were 45.1% (95%CI: 30.8-60.3%) and 99.6% (95%CI: 96.5-99.9%). The summary diagnostic odds ratio (DOR) for TCD (DOR=297.97, 95%CI: 131.18-676.83) and TTE (DOR=193.44, 95%CI: 30.38-1231.67) did not significantly differ (z-value=0.418, p=0.676). TTE was superior in terms of higher positive likelihood ratio values (LR+= 106.61, 95%CI: 15.09-753.30 for TTE vs. LR+=12.62, 95%CI: 6.52-24.43 for TCD; p=0.043), while TCD yielded lower negative positive likelihood values (LR- = 0.04, 95%CI: 0.02-0.08) compared to TTE (LR- =0.55, 95%CI: 0.42-0.72; p<0.001). Finally, the area under the summary receiver operating curve was significantly greater (p<0.001) in TCD (AUC=0.98, 95%CI: 0.97-0.99; Figure A) compared to TTE studies (AUC=0.86, 95%CI: 0.82-0.89; Figure B). Conclusions: TCD is more sensitive but less specific compared to TTE for the detection of PFO in patients with cryptogenic cerebral ischemia. The overall diagnostic yield of TCD appears to outweigh that of TTE.

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