PFO prevalence high among children with migraine with aura
MedWire News: Children with migraine with aura have a significantly higher prevalence of patent foramen ovale (PFO) - a congenital heart defect - than those who do not present with aura and those in the general population, show US study findings.
"These data suggest that PFO may contribute to the pathogenesis of migraine with aura in children and have implications for clinical decision making," say Rachel McCandless (University of Utah, Salt Lake City) and co-authors.
For the study, the team evaluated 109 children aged 6-18 years with migraine headache for symptoms of PFO and right-to-left atria shunting using color-flow Doppler scanning, saline solution contrast transthoracic echocardiography (TTE), and contrast transcranial Doppler (TCD) scanning.
Contrast TTE revealed that the overall incidence of PFO was similar to that in the general population, at 35% and 25%, respectively.
However, subtype analysis showed that the 35% of children who had migraine with aura were significantly more likely to have PFO than the general population (50 vs 25%, respectively), while those without aura had a similar PFO prevalence to that in the general population (27 and 25%, respectively).
Contrast TCD detected PFO in 37 children, and findings correlated well with contrast TTE. Compared with contrast TTE, contrast TCD had a sensitivity of 95% and a specificity of 100%.
Among the 37 patients with contrast TCD evidence of a PFO, nine, 17, and 11 showed small, medium, and large shunts, respectively. Shunt size did not correlate with migraine subtype.
Moderately disabling migraines were observed in 34% of patients, with no significant difference seen in mean scores on the PedMIDAS headache assessment tool between those experiencing migraines with and without aura. In addition, no significant difference in mean PedMIDAS score was observed between those with a PFO versus those without a PFO.
"If a causal link is established between PFO and migraine, routine investigation for PFO with contrast TTE may be indicated for all children with migraine headaches," comment the researchers in the Journal of Pediatrics.
By Ingrid Grasmo