Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure

M Khalid Mojadidi,1 Hamidreza Khessali,1 Rubine Gevorgyan,1 Ralph D Levinson,2 Jonathan M Tobis11Division of Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, 2Division of Comprehensive Ophthalmology and Ocular Inflammatory Disease Center, Jules Ste...

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Autores principales:	Mojadidi MK, Khessali H, Gevorgyan R, Levinson RD, Tobis JM
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/507d330b908a441fb2120aaaa9280006
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spelling	oai:doaj.org-article:507d330b908a441fb2120aaaa92800062021-12-02T07:42:31ZVisual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure1177-54671177-5483https://doaj.org/article/507d330b908a441fb2120aaaa92800062012-07-01T00:00:00Zhttp://www.dovepress.com/visual-migraine-aura-with-or-without-headache-association-with-right-t-a10418https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483M Khalid Mojadidi,1 Hamidreza Khessali,1 Rubine Gevorgyan,1 Ralph D Levinson,2 Jonathan M Tobis11Division of Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, 2Division of Comprehensive Ophthalmology and Ocular Inflammatory Disease Center, Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, CA, USABackground: Right to left shunting, usually caused by a patent foramen ovale (PFO), is associated with migraine and visual aura. It is unknown if patients who present with visual aura without headache behave similarly to those experiencing typical migraine headache with aura. The purpose of this study was to assess the prevalence of right to left shunting in patients who present with migraine aura without headache and evaluate the response to PFO closure.Methods: The records of patients referred to the Interventional Cardiology program at the University of California at Los Angeles for suspected intracardiac right to left shunt were reviewed. Individuals with visual auras with or without migraine headaches were divided into three groups: group A (aura + migraine), migraine aura during or within 60 minutes of headache; group B (migraine aura unrelated to headache), migraine aura and headache temporally unrelated; and group C (migraine aura only), isolated migraine visual aura without a history of headaches. The presence of right to left shunt was assessed using transcranial Doppler with an agitated saline test. PFO closure was performed in 80 patients. Residual headache and migraine visual aura were assessed 3 and 12 months after the procedure. The control group consisted of 200 patients referred for diagnostic cardiac catheterization.Results: Of 590 referred patients, 225 had migraine visual aura with or without headache. The prevalence of right to left shunt was similar (P = 0.66) in groups B (21/29, 72%) and C (14/21, 67%). Group A patients had a higher prevalence of right to left shunt (168/175, 96%) due to selection bias. The prevalence of right to left shunt in the control group was significantly (P &lt; 0.0001) lower (36/200, 18%) than in groups A, B, and C. At 12 months after PFO closure, visual aura was resolved in 52%, 75%, and 80% of patients in groups A, B, and C, respectively (difference not statistically significant).Conclusion: There is an increased prevalence of PFO among patients with migraine aura without headache. The closure of PFO correlates with improvement of the visual aura, suggesting a causative association between the presence of PFO and both visual aura and migraine headaches. Ophthalmologists should be aware of the association of right to left shunts with visual aura.Keywords: visual aura without headache, right to left shunt, patent foramen ovaleMojadidi MKKhessali HGevorgyan RLevinson RDTobis JMDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2012, Iss default, Pp 1099-1105 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Mojadidi MK Khessali H Gevorgyan R Levinson RD Tobis JM Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure
description	M Khalid Mojadidi,1 Hamidreza Khessali,1 Rubine Gevorgyan,1 Ralph D Levinson,2 Jonathan M Tobis11Division of Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, 2Division of Comprehensive Ophthalmology and Ocular Inflammatory Disease Center, Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, CA, USABackground: Right to left shunting, usually caused by a patent foramen ovale (PFO), is associated with migraine and visual aura. It is unknown if patients who present with visual aura without headache behave similarly to those experiencing typical migraine headache with aura. The purpose of this study was to assess the prevalence of right to left shunting in patients who present with migraine aura without headache and evaluate the response to PFO closure.Methods: The records of patients referred to the Interventional Cardiology program at the University of California at Los Angeles for suspected intracardiac right to left shunt were reviewed. Individuals with visual auras with or without migraine headaches were divided into three groups: group A (aura + migraine), migraine aura during or within 60 minutes of headache; group B (migraine aura unrelated to headache), migraine aura and headache temporally unrelated; and group C (migraine aura only), isolated migraine visual aura without a history of headaches. The presence of right to left shunt was assessed using transcranial Doppler with an agitated saline test. PFO closure was performed in 80 patients. Residual headache and migraine visual aura were assessed 3 and 12 months after the procedure. The control group consisted of 200 patients referred for diagnostic cardiac catheterization.Results: Of 590 referred patients, 225 had migraine visual aura with or without headache. The prevalence of right to left shunt was similar (P = 0.66) in groups B (21/29, 72%) and C (14/21, 67%). Group A patients had a higher prevalence of right to left shunt (168/175, 96%) due to selection bias. The prevalence of right to left shunt in the control group was significantly (P &lt; 0.0001) lower (36/200, 18%) than in groups A, B, and C. At 12 months after PFO closure, visual aura was resolved in 52%, 75%, and 80% of patients in groups A, B, and C, respectively (difference not statistically significant).Conclusion: There is an increased prevalence of PFO among patients with migraine aura without headache. The closure of PFO correlates with improvement of the visual aura, suggesting a causative association between the presence of PFO and both visual aura and migraine headaches. Ophthalmologists should be aware of the association of right to left shunts with visual aura.Keywords: visual aura without headache, right to left shunt, patent foramen ovale
format	article
author	Mojadidi MK Khessali H Gevorgyan R Levinson RD Tobis JM
author_facet	Mojadidi MK Khessali H Gevorgyan R Levinson RD Tobis JM
author_sort	Mojadidi MK
title	Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure
title_short	Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure
title_full	Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure
title_fullStr	Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure
title_full_unstemmed	Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure
title_sort	visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/507d330b908a441fb2120aaaa9280006
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Visual migraine aura with or without headache: association with right to left shunt and assessment following transcutaneous closure

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