Migraine linked to ‘hole in the heart’, study reveals mechanism

First explained the pathophysiological mechanism that correlates migraine with aura to the congenital heart defect of the patent foramen ovale (PFO) – commonly called ‘hole in the heart’ – that is, the lack of total closure at birth of communication between the right and left atrium. The mechanism is described in a study by the Monzino Cardiology Center and the State University of Milan, published today in the ‘Journal of American College of Cardiology Basic to Translational Science’. The research also confirms the already known regression data of migraine crises in about 70% of cases following percutaneous closure of the foramen ovale. Several observational studies – report from Monzino – had already highlighted a relationship between migraine with aura and PFO, reporting that about 35% of subjects with PFO suffer from migraine with aura (70% women) and that in these patients the attacks of migraines disappear or are significantly reduced after the interventional foramen closure procedure. However, the mechanism that links PFO and migraine with aura symptom has never been clarified. “To date, none of the international cardiological guidelines includes migraine with aura among the indications for PFO closure surgery. disabling pathology, which in many cases does not respond to drugs and occurs incessantly for days, once or even more times a month, preventing normal everyday life and planning of life. For this reason at Monzino – explains Daniela Trabattoni, head of the Cardiology Unit interventionist 3 of the IRCCS and coordinator of the clinical part of the study – thanks to our successful case studies in the treatment of PFO, we decided to research the pathophysiological mechanism of connection between the two pathologies, to demonstrate, at the level of cellular mechanisms, such as closure of the foramen may actually prevent the onset of migraine attacks with aura “.” Our study ‘Learner’ (pLatelEts and migRaine iN patEnt foRamen ovale) analyzed 62 symptomatic patients for migraine with aura on cardioaspirin therapy before surgery and 6 months after percutaneous PFO closure. We found that aspirin improves migraine attacks with aura, but does not resolve them, while closure achieves complete regression in 69.7% of cases, “continues Trabattoni.” PFO closure abolishes the oxidative stress that causes l platelet activation; as a direct consequence of this, in fact, platelets lose the activated phenotype and the ability to form microemboli, returning to circulate in the blood to carry out normal haemostatic functions “, underlines Marina Camera, associate professor of the Department of Pharmaceutical Sciences of the University of Studies of Milan and head of the Monzino Cardiovascular Cell and Molecular Biology Research Unit, which coordinated the pharmacological-molecular part of the study. “By analyzing the patients’ blood – he continues – we observed that the remission effect of platelet activation can also be obtained with antiplatelet drugs such as clopidogrel. However, the advantage conferred by the closure of the PFO, compared to the pharmacological treatment of the patient, is that this procedure allows to remove the cause of platelet activation, while the second would only treat the effect of oxidative stress on the platelet, however, forcing the patient to a chronic therapy “. In light of the new scientific evidence obtained, the researchers conclude,” we hope to convince neurologists and cardiologists, through their respective scientific societies, to recommend percutaneous closure of the PFO in all cases of patients with migraine with aura refractory to medications. In the meantime, it is important for these patients to know that we have an effective weapon to say goodbye to their feared seizures and to protect the brain from risky ischemias. “