Page 69 - Migraine, the heart and the brain

selective elimination of attacks of migraine with aura in participants in whom large spontaneous PFOs had been closed (presented at the Transcatheter Cardiovascular Therapeutics Meeting, Washington, DC, September 2014).
Presence of RLS was not associated with higher prevalence of silent infarcts in the posterior circulation; this is in line with studies reporting that RLS is not associated with speci c ischemic patterns.34
Furthermore, there was no association of RLS with deep white matter 3 hyperintensities or infratentorial hyperintensities, which is in line with other
studies.35,36
The design and study population of the present study allow for a broad extrapolation of the results to the average migraine patient. Although still too small for additional subgroup analyses, the study sample should be considered large in view of the fact that all participants had brain MRI. Moreover, the study participants were drawn from a phenotypically well-defined, general population- based, long-term follow-up study,20,37 and their clinical characteristics covered a wide range of disease severities and attack frequencies. The fact that even patients were included in whom attacks had ceased recurring enabled reliable analysis of the relationship between RLS and persistent migraine activity at older age. Compared to methods used in most other studies, TCD-c, although less specific for subtype, is more sensitive for detecting RLS. Finally, both TCD-c and MRI were performed and interpreted by investigators who were strictly blinded to the clinical diagnoses and characteristics of the participants.
Migraine with aura, but not without aura, is associated with increased prevalence of in particular large RLS. Spontaneous, but not Valsalva-induced, RLS are associated with persistent recurrence of migraine attacks beyond the age most patients normally cease having attacks. Finally, RLS were not associated with increased risk of ischemic brain lesions, irrespective of comorbid migraine status.
aCknoWledgment
the authors thank the RIVM, for allowing its cohort members to be part of the CAMERA study.
Right-to-left shunts and migraine
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