| Part I Clinical analysis of migraine patients with patent foramen ovale and subclinical myelinopathyObjective:To observe the incidence of patent foramen ovale (PFO) in migraine patients and study the clinical features and drug prevention effect of migraine patients with PFO by comparing with migraine patients without PFO. To study the prevalence of white matter lesions (WMLs) in migraine patients with PFO.Methods:95migraine patients were chosen from October,2011to November,2012in Shandong Provincial Hospital. The patients met the diagnostic criteria. Individuals with other primary headaches or secondary headaches were excluded. Those with severe cardiovascular diseases were also excluded. All the patients were conducted detailed inquiry, physical examination and migraine disability assessment scale (MIDAS). And they were tested by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). The patients’ age, gender, aura, frequency of headache, duration and severity of headache were recorded. All the patients were treated with5mg flunarizine for three months. Every headache index was observed again after three-month treatment.Results:There were29patients with PFO and66patients without PFO in TTE test. The incidence of migraine patients combined with PFO was30.5%. In PFO group, there were16(55.2%) migraine patients with aura, and the headache frequency was (4.8±2.3) times/month. In non-PFO group, there were22(33.3%) migraine patients with aura, and the headache frequency was (3.5±2.1) times/month. Compared to non-PFO group, the proportion of migraine with aura and the frequency of attack in PFO group was significantly higher (P=0.045, P=0.015respectively). There were no significant differences in duration and severity of headache, MIDAS scores and the incidence of WMLs between the two groups (P>0.05). After three-month treatment, there was a significant decrease of headache frequency, duration, severity and MIDAS scores in the two groups (P<0.05). There were no significant differences between the two groups (P>0.05).Conclusions:1. There was a higher prevalence of migraine with aura and a higher frequency of attack in migraine patients with PFO. Flunarizine was effective in preventing migraine with PFO.2. Migraine with PFO didn’t increase the incidence of WMLs. Part Ⅱ Clinical features and risk factors of migraine-related white matter lesionsObjective:To explore the incidence and predilection sites of white matter lesions (WMLs) in migraine patients. To study the clinical features and risk factors of migraine-related WMLs.Methods:110migraine patients with MRI and magnetic resonance angiography (MRA) scans from October,2010to August,2013in Shandong Provincial Hospital were chosen as migraine group (34males and76females, age range18-49years). Another110age-and sex-matched healthy subjects from examination center were enrolled as control group. The incidence of WMLs was compared between the two groups. Based on the presence or absence of WMLs in MRI scans,110migraine patients were divided into two subgroups: WMLs subgroup (patients with WMLs) and non-WMLs subgroup (patients without WMLs). Clinical features of the patients were compared between the two subgroups, including the general information, disease duration, aura, frequency of headache, duration of each attack, severity and family history of migraine. Imaging features of WMLs were recorded. Logistic regression analysis was performed to study the possible risk factors of brain WMLs in migraine patients.Results:There were36patients with WMLs among the110migraine patients. The incidence of migraine patients combined with WMLs was32.7%, significantly higher than that in control group (10.9%, P<0.001). The predilection sites of WMLs in migraine patients located mostly in frontal lobes (36.4%), parietal lobes (22.7%) and basal ganglia (20.5%). Compared to non-WMLs subgroup, there were no significant differences in gender (P=0.350), age (P=0.276), headache duration (P=0.136), headache severity (P=0.756) and concomitant symptoms (P=0.620) in WMLs subgroup. There were significant differences in disease duration (P=0.005), frequency of attack (P=0.016), aura (P=0.049) and family history of migraine (P<0.001) between the two subgroups. Logistic regression analysis identified that the family history of migraine (OR8.735,95%CI2.472-30.865), aura (OR3.902,95%CI1.272-11.968) and disease duration (OR1.162,95%CI1.027-1.315) were independent risk factors for migraine patients with WMLs.Conclusion:1. There was a higher incidence of WMLs in migraine patients.2. Migraineurs with WMLs had longer disease duration, higher attack frequency and most had migraine aura and a family history of migraine.3. The disease duration, aura and family history were independent risk factors for migraine patients with WMLs. |
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