Page 83 - Migraine, the heart and the brain
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Right-to-left shunts and micro-embolization in migraine
USA) and Prima (openlabel, Canada and Europe) trials, both by AGA Medical Corporation (St. Paul, Minnesota, USA) started in 2006, are still recruiting (http:// www.con trolled-trials.com). A single-arm study on migraine prophylaxis is planned by Coherex, Salt Lake city, Utah, USA (http://clinicaltrials.gov).
ConClusion
There is reasonable evidence that migraine with aura is associated with RLS [15], and
this is not altered by recent negative studies [12,16,18]; however, the difference might
not be as marked as reported initially [1 – 4]. Signi cant gaps in our understanding of 4 this association remain. In mice, it was demonstrated that arterial emboli were able to
trigger CSD, which supports the hypothesized embolic mechanism linking RLS with
migraine aura [22]. In humans, several kinds of emboli have been associated with
migraine attacks. Reported frequencies vary widely, probably a nocebo effect of the
aircontrast procedure plays an important role. There is insuf cient evidence that RLS
closure has a bene cial effect on migraine. Therefore, diagnosis or treatment of RLS
in migraineurs has no place in current clinical practice and should as such only take
place in controlled studies.
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