Identification of potential influencing factors associated with elimination of migraine headache in patients with PFO after percutaneous closure / 中华心血管病杂志

Objective: To recognize the potential factors that contribute to the eradication of migraine headache in patients with patent foramen ovale (PFO) at one year after percutaneous closure. Methods: A prospective cohort study was conducted, which enrolled patients diagnosed with migraines and PFO at the Department of Structural Heart Disease, First Affiliated Hospital of Xi'an Jiaotong University between May 2016 and May 2018. The patients were segregated into two groups based on their response to treatment, and one group showed elimination of migraines while another did not. Elimination of migraines was defined as a Migraine Disability Assessment Score (MIDAS) score of 0 at one year postoperatively. Least Absolute Shrinkage and Selection Operator (LASSO) regression model was utilized to identify the predictive variables for migraine elimination post-PFO closure. Multiple logistic regression analysis was employed to determine the independent predictive factors. Results: The study enrolled a total of 247 patients, with an average age of (37.5±13.6) years, comprising 81 male individuals (32.8%). One year after closure, 148 patients (59.9%) reported eradication of their migraines. Multivariate logistic regression analysis revealed that migraine with or without aura (OR=0.003 9, 95%CI 0.000 2-0.058 7, P=0.000 18), a history of antiplatelet medication use (OR=0.088 2, 95%CI 0.013 7-0.319 3, P=0.001 48) and resting right-to-left shunt (RLS) (OR=6.883 6, 95%CI 3.769 2-13.548 0, P<0.001) were identified as independent predictive factors for elimination of migraine. Conclusion: Migraine with or without aura, a history of antiplatelet medication use, and resting RLS are the independent prognostic factors associated with elimination of migraine. These results provide important clues for clinicians to choose the optimal treatment plan for PFO patients. However, further studies are needed to confirm these findings.

Migraña: efectividad del tratamiento quirúrgico: revisión de la literatura / Migraine headache: effectiveness of surgical treatment: review of the literature

Resumen La migraña afecta a un porcentaje importante de la población y los síntomas pueden interferir con calidad de vida de manera importante. A pesar de los avances en el manejo médico, existe una proporción de pacientes que no responden adecuadamente a la intervención farmacológica. En los últimos años, se han planteado nuevos enfoques en el tratamiento de la migraña. Éstos se basan en la teoría que ramas sensoriales extracraneales del trigémino y de los nervios espinales cervicales pueden irritarse, atraparse o comprimirse en algún punto a lo largo de su trayecto, generándose una cascada de eventos fisiológicos que finalmente resulta en la migraña. Se ha demostrado que la inyección diagnóstica y terapéutica de toxina botulínica y la descompresión quirúrgica de estos puntos gatillos reducen o eliminan las migrañas en pacientes que no responden adecuadamente a la intervención farmacológica y siguen sintomáticos. La evidencia que respalda la eficacia y seguridad de la descompresión quirúrgica de los puntos de gatillos periféricos se está acumulando rápidamente, y la tasa de éxito general de la cirugía se acerca a 90%. Este trabajo revisa la evidencia clínica y pretende proporcionar un artículo sobre el estado actual de la técnica en el tratamiento quirúrgico de las migrañas.

Migraine headaches affect a significant percentage of the population and the symptoms can interfere with quality of life in an important way. Despite advances in medical management, there is a proportion of patients who do not respond adequately to the pharmacological intervention. In recent years, new approaches have been proposed in the treatment of migraine. These are based on the theory that extracranial sensory branches of the trigeminal and cervical spinal nerves can become irritated, trapped or compressed at some point along their path, generating a cascade of physiological events that ultimately results in migraine. It has been shown that the diagnostic and therapeutic injection of botulinum toxin and the surgical decompression of these trigger points reduce or eliminate migraines in patients who do not respond adequately to the pharmacological intervention and remain symptomatic. The evidence supporting the efficacy and safety of surgical decompression of peripheral trigger points is rapidly accumulating, and the overall success rate of surgery approaches 90%. This paper reviews the clinical evidence and aims to provide an article on the current state of the art in the surgical treatment of migraines.