Page 169 - Migraine, the heart and the brain

Our study (Chapter III) was the rst to include both migraineurs with persistent migraine activity as well as migraineurs who had ceased having attacks. We showed that persistence of activity was related to the presence of spontaneous RLS.
This is in line with the theory in which RLS enables passage of emboli. However it is evident that the presence of RLS not fully explains the occurrence migraine aura, as not all migraineurs with aura have a RLS, and migraineurs without aura also (but in a lower percentage) have RLS and never experience an aura. Well designed randomized, sham-controlled, RLS closure studies are needed to prove if this association is causal.
RLS was not associated with subclinical cerebellar infarcts, although there was a trend for this association in the posterior circulation. (Chapter III)
Several studies provided evidence that RLS (speci c patent foramen ovale) is associated with clinical (crypotogenic) stroke. Well known risk factors for ischemic (silent) stroke are hypertension, smoking, diabetes and atrial brillation.17 The additional risk of an RLS probably is relatively small. Due to limited number of cerebellar infarcts, adjustments for all major riskfactors on methodological grounds unfortunately in our study was not possible. Except for some studies 18;19 showing that cardiac emboli favor the posterior cerebral circulation, there are no good explanations why RLS subjects in our study showed a trend for more cerebellar silent infarcts. In a migraine patient who suffers a (silent) stroke in the posterior circulation and who does not have additional cardio-vascular risk factors, screening for RLS seems a reasonable advice.
We also showed that aortic root replacement in a heterogeneous group of cardiac patients was associated speci c with migraine with aura. (Chapter V)
We were the rst to show that the increased migraine (in particular with aura)
prevalence among Marfan patients was speci cally found in the group who
underwent aortic root replacement. Several other large vessel diseases have been 9 associated with migraine. For example being a migraineur doubled the risk of carotid
artery dissection 20 and subjects with angiographically con rmed carotid artery
dissection have been described with attacks of transient symptoms exactly resembling
migraine wit aura. Recently a genetic study on carotid dissection and a study on
migraine both identi ed the same variant on chromosome 6 (PHACTR1 gene),
reducing the risk of carotid dissection as well as the risk of migraine with aura.21-22
Interestingly wide aortic root diameter also is a risk factor of carotid dissection,23-24
Summary and general discussion
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