Page 20 - Migraine, the heart and the brain

Chapter 1
The remaining question to be answered is, if RLS explains (silent) infarcts in migraine. If that is true, one could think of a continuous spectrum with emboli triggered migraine aura attacks on one side and (sub-) clinical ischemic stroke on the other side. RLS enables emboli passing from the venous circulation to the brain, and consequences of emboli might be transient or permanent. Studies describing silent ischemic lesions and PFO or RLS are scarce, and did not show a relation between RLS and white matter lesions.55;56 In Chapter III we describe RLS and its relation with silent infarcts in the CAMERA-II study.
Cardiac monitoring in high dose verapamil.
The heart can also be influenced by preventive medication as used for cluster headache or familial hemiplegic migraine. Treatment guidelines recommend verapamil in doses which usually exceed those generally used in cardiovascular disease. Although cardiac adverse events and EKG abnormalities are relatively common, evidence- based guidelines for screening and monitoring patients on high dose verapamil are lacking. Using the Delphi method we questioned clinical experts in cardiac rhythm disorders to formulate EKG guidelines for the pretreatment screening and monitoring of headache patients using high dose verapamil.(Chapter VI)
iii. migraine and brain funCtion and impaCt of isChemiC lesions on brain funCtion of migraineurs
All previous studies on motor- and cognitive function in migraine patients were done without correlation with ndings on MRI of the brain. Several studies indicated that migraineurs in between their attacks (interictally) have impaired cognitive functions like memory57 executive function58 and visual processing.59 However other studies did not nd cognitive impairment interictally.60;61 Also interictal impaired cerebellar or balance function have been reported.62-64 These studies were mostly clinic based and unblinded (i.e., investigators were aware of patient or control status), which are both regarded as important methodological limitations. Whether MRI ndings in the brain, such as white matter lesions or silent infarcts influence cognition and other brain functions in migraineurs in unknown. Present knowledge on cognitive performance as well as motor function in migraineurs will be summarized. In addition, literature on white matter lesions and cognitive functions will be evaluated.
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