Migraine as predictive factor of the presence of atrial septum aneurysm in patients with stroke and patent foramen ovale

Introduction. Ischemic stroke in young patients is associated in up to 30% of cases to a patent foramen ovale (PFO) with or without atrial septum aneurism (ASA). Besides, a frequent association between migraine and PFO has been described, but few studies have addressed the possible association between ASA and migraine in stroke patients. Methods. Observational study with inclusion of consecutive ischemic stroke patients in a Stroke Unit Data Bank of the Department of Neurology of a university hospital admitted between January 1994 and December 2005. Those patients who underwent transesophageal echocardiography (TEE) were selected and classified in two groups regarding the history of previous migraine. Logistic regression analysis models were developed to assess the risk of the combination of PFO and ASA in patients with migraine. Results. 631 stroke patients with TEE were included. PFO was present in 61 patients (9.7%), isolated ASA in 34 (5.4%) and both abnormalities in 22 (3.49%). Patients with migraine and PFO had higher frequency of ASA than those with PFO and no migraine (75 vs 30.2%), and the relative risk to carry double interatrial septal abnormalities was 2.5 (95% confidence interval: 1.4-4.4). In the subgroup of patients under 55 years old, migraine history was associated to a nine-folder relative risk of carrying this combination, independently of age or gender. Conclusions. In patients with ischemic stroke and PFO the probability of having ASA could be higher in migrainous. This finding could have diagnostic implications, suggesting the convenience to seek for this association in these patients.