A Matter of the Heart?
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Migraine is a primary chronic-intermittent headache disorder that affects ≈12% of the population, with women being 3 to 4 times more likely to have migraine than men at any given age.1 Migraine typically starts before age 40, and its 1-year prevalence peaks in midlife. The pain character is moderate to severe and of pulsating quality, and headache attacks are accompanied by various combinations of gastrointestinal, autonomic nervous system dysfunction, as well as sensitivity to light and sound. In some patients, transient neurological symptoms occur that mostly involve the visual field and include flickering light, light spots or lines, or partial vision loss but can also involve the sensory or motor system. These symptoms, known as migraine aura, usually last for <30 minutes and affect as many as one third of migraine patients. The pathophysiology of migraine has been explored in detail, and it is known that a dysfunction of brain cells and brain arteries is a major component of this disorder.2
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In recent decades, migraine, and specifically migraine with aura, has been consistently associated with increased risk of ischemic stroke, particularly among young women.3–6 Despite several hypotheses, the mechanisms explaining this association are not fully understood.7 Because patent foramen ovale (PFO) can be a cause of ischemic stroke among young individuals, it has been suggested that this congenital heart defect may be involved in the association between migraine with aura and ischemic stroke.
PFO is an often-asymptomatic condition that is present in ≈25% of the general population, and at first glance migraine and PFO have little in common. In recent years, however, several clinic-based case-control studies have suggested that PFO is more common among individuals with migraine with aura and that migraine with aura is more common among individuals with PFO.8–12 This …