Page 170 - Migraine, the heart and the brain

Chapter 9
and widening of the aortic root in Marfan patients was the main reason to perform aortic root replacement. An underlying large artery arteriopathy is evident in Marfan and believed in carotid dissection. Also in reversible vasoconstriction syndrome (RCVS), migraine is considered a risk factor. And some patients both have RCVS and carotid dissection, and 60% of these subjects were migraineurs.25 All these ndings point towards a role of abnormal large vessel dilatation (or altered cerebrovascular tone) in migraine, although the mechanisms and possible causative link remain to be proved.
The Delphi approach was used to de ne recommendations from cardiologists specialized in rhythm disorders for safe use and EKG monitoring of high dose of verapamil. These experts agreed on performing a pretreatment EKG in patients using verapamil for the rst time. Pretreatment EKG was deemed not necessary in subjects who did not have cardiac adverse events during a previous period of verapamil use. No consensus was reached on EKG monitoring during verapamil treatment and dose adjustments. Consensus about absolute and relative contra-indications for continuing high dose verapamil largely followed FDA recommendations.No consensus-based recommendations on EKG monitoring during verapamil treatment and around dose increases can be given although, based on the literature EKG prior and after every dose increase would be our recommendation. Individual patient characteristics always have to be taken into account.
(Chapter VI)
iii migraine and brain funCtion
We did not nd any impaired interictal (in between attacks) cognitive function in migraine using a large battery of neuropsychological tests covering function of supratentorial brain structures. (Chapter II). We did show that a high white matter lesion load was probably (trend) associated with impairment of memory. This again did not differ between migraineurs and controls. (Chapter II, etable 3) In our study evaluating cognitive function shortly after a migraine attack, we found interictal differences unrelated to the previous attack. Migraineurs showed impairment in the processing of global visual features compared with controls. (Chapter VIII)
Some studies reported inter-ictal cognitive de cits in migraineurs, while other reported no differences between migraine and controls.26-30 The previously found
168