Botulinum therapy for chronic migraine.

Chronic migraine (CM) is an important cause of chronic daily headache (CDH), a common severe headache syndrome. Patients with CM are significantly disabled from employment and overuse pain relieving medications. CM is a difficult condition to treat. Overuse of abortive medications and limited benefit from oral preventive medications are an important problem in managing this condition. Recent randomized controlled trials evaluating the efficacy of botulinum toxin A (BoNT-A) have confirmed its efficacy for CM prophylaxis. BoNT-A is a safe drug with no systemic reactions in clinical trials for headache.

Patent foramen ovale and stroke: coincident or real association.

Stroke is a common cause of morbidity and mortality. Approximate 40% of strokes are cryptogenic, because patent foramen ovale (PFO) is commonly found in the normal population. They are conflicting data from studies examining the association between PFO and stroke. Various factors need to be considered such as atrial anatomic variations (PFO size, atrial septal aneurysm, eustachian valve anatomy), the presence of venous thrombosis, and the presence of hypercoagulable state. The presence of any of these findings increases the chance of PFO contributing to a stroke. Limited information suggests no advantage of warfarin over aspirin in preventing recurrent strokes. Both surgical and transcatheter devices have been shown to decrease the rate of subsequent embolic events substantially. Surgical and percutaneous PFO closures have not been directly compared. However, the percutaneous approach appears to be less invasive and so successful that it seems to be a reasonable consideration for first choice treatment of PFO.