| BackgroundHeadache is a common symptom in neurology in the clinic.According to the etiology,headache can be divided into primary headache and secondary headache.Primary headache mainly includes migraine,tension-type headache,cluster headache,etc.Secondary headache mainly includes head caused by head and neck trauma,craniocerebral or cervical vascular disease,intracranial non-vascular disease,drug withdrawal,infection,etc.Among them,tension-type headache and migraine are the most common types of primary headache,and the pathogenesis is not completely clear,which seriously affects patients'daily life and imposes a heavy burden on society.In recent years,studies have found that'right-to-left shunt(RLS)is closely associated with unexplained embolism.youth stroke,and migraine.RLS can be divided into intracardiac shunt and extracardiac shunt.wherein the patent foramen ovale(PFO)is the most common right-to-left shunt,accounting for 95%.The foramen ovale is located at the junction of the primary interatrial septum and the secondary interatrial septum at the embryonic stage,and is usually closed within 1 year after birth.If it is not closed after three years old,which is called patent foramen ovale.Because the partial flow of the patent foramen ovale is very small,it does not cause clinical symptoms such as chest tightness and hernia,and cardiac structure change.it is difficult to detect the patent foramen ovale by conventional echocardiography.The importance of patent foramen ovale has not been recognized for a long time.ln recent years,more and more studies have found that the incidence of young stroke,migraine and decompression sickness in patients with PFO is higher than that of normal people.PFO has attracted the attention of scholars.At present,interventional closure is a common surgical method for the treatment of patent foramen ovale,but previous studies have rarely analyzed the efficacy of patients with different types of headache combined with patent foramen ovale and headache with different grades of right-to-left shunt.ObjectiveTo evaluate the efficacy and safety of interventional closure in patients with headache combined with patent foramen ovale.To analyze whether there was any difference in the patients suffered from different types of headache combined with patent foramen ovale,and to analyze whether there was any difference in the degree of headache relief in patients with different grades of right-to-left shunt.MethodsA total of 49 patients with headache complicated with patent foramen ovale were enrolled in Qilu Hospital of Shandong University from January 2016 to January 2019.The onset time,the frequency,degree and nature of headache,and the presence or absence of aura,with or without concomitant symptoms(nausea,vomiting,photophobia,and phobia)were recorded in detail.Besides the routine examination,patients shoule be received contrast transcranial Doppler ultrasonography(c-TCD),contrast transthoracic echocardiography(c-TTE)and contrast transesophageal echocardiography(c-TEE).Patients who are confirmed to exist patent foramen ovale and right-to-left shunt,are received interventional closure.After successful interventional closure,patients are received bedside echocardiography immediately,to observe the closure and diversion.After interventional closure,electrocardiogram and echocardiography were conducted in outpatient department at 1 month,3 months and 6 months after the operation to evaluate whether there were postoperative complications..The headache impact test-6 score was performed before and after interventional closure,to assess the patient's headache relief.Preoperative and postoperative differences were analyzed by paired t-test.One-way analysis of variance was used to compare the differences between migraine with aura,migraine without aura and tension-type headache.Single-factor linear regression analysis was used to analyze c-TCD grading and c-TTE.Correlation between grading,c-TEE grading and degree of headache relief.Univariate linear regression was used to analyze the correlation between c-TCD grade,c-TTE grade,c-TEE grade and the degree of headache remission.ResultsA total of 49 patientswas received interventional closure successfully.During the follow-up,no occluder displacement was observed and the function of the heart valves was not affected.A total of 49 patients with headache were included in the study,including 18 males and 31 females,with an average age of 38.38±14.09 years.Among them,12 patients with migraine with aura,23 patients with migraine without aura,and 13 patients with tension-type headache.The preoperative HIT-6 score of 49 patients was 63.12±8.14.,and the postoperative score was 47.22±9.98.Compared with preoperative,the headache symptoms take a turn for the better significantly,and the difference was statistically significant(P<0.05).In patients with migraine with aura,migraine without aura,and tension-type headache,HIT-6 score had a statistically significant difference in postoperative compared with preoperative(P<0.05).There was no significant difference in headache relief between migraine,migraine without aura and tension headache(P>0.05).In patients with negative c-TCD before the interventional closure,postoperative HIT-6 score was not statistically significant compared with preoperative(P>0.05);preoperative c-TCD was positive,postoperative HIT-6 score was statistically significant compared with preoperative(P<0.05);In patients with negative c-TTE,the postoperative HIT-6 score was not statistically significant compared with preoperative(P>0.05);preoperative c-TTE was positive,the postoperative HIT-6 score was statistically significant compared with preoperative(P<0.05);whatever the c-TTE is negative or positive,the postoperative HIT-6 scores were statistically significant compared with preoperative(P<0.05).Univariate linear regression analysis was used to analyze the correlation between c-TCD grading,c-TTE grading,c-TEE grading and headache remission.We found that c-TCD grading and c-TTE grading were positively correlated with headache remission(P<0.05).There was no correlation between c-TEE grade and headache relief(P>0.05).Conclusion1.Interventional closure is safe;2.Patients with migraine with aura,migraine without aura,and tension-type headache have significantly relieved headache symptoms after interventional closure.There is no significant difference in headache relief between the three types of headaches;3.Patients with c-TCD,c-TTE negative showed no significant relief in headache symptoms compared with that before interventional closure.Patients with c-TCD,c-TTE positive showed significant relief in headache symptoms compared with that before interventional closure;patients with c-TEE negative and c-TEE positive showed significant relief in headache symptoms compared with that before interventional closure.4.The grade of c-TCD and c-TTE can predict the degree of headache relief after interventional closure,while c-TEE cannot predict the effect of interventional closure. |
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