Faculty of Medicine, Universitas Muhammadiyah Prof. DR. Hamka, Tangerang, Banten, Indonesia.
Laboratory of Neuroscience, Faculty of Medicine, Universitas Muhammadiyah Prof. DR. Hamka, Jakarta, Indonesia.
Am J Case Rep. 2024 Sep 28;25:e944848. doi: 10.12659/AJCR.944848.
BACKGROUND Migraine, a prevalent primary headache disorder, often disrupts daily life, particularly when accompanied by visual auras. While the etiology of migraines remains elusive, emerging evidence suggests a correlation with cardiovascular anomalies. CASE REPORT This case involves a 35-year-old woman experiencing migraine with aura. Imaging studies, including MRI/A, revealed small-vessel ischemic damage in the right frontal region and historical microbleeds in the right occipital area. The patient's RoPE score was a high 9 out of 10, and a grade 4 (severe) PFO was diagnosed following a TEE+bubble test. A transfemoral PFO closure was successfully performed using a 25-mm Amplatzer PFO occluder device via an antegrade transvenous approach without fluoroscopy. The patient was discharged in stable condition, with no migraine episodes reported at 5-month follow-up. The detection of PFO in young migraineurs, particularly those with aura, is crucial and warrants thorough investigation during their assessment and treatment. CONCLUSIONS This case underscores the importance of incorporating cardiac evaluations in the diagnostic regimen for young individuals presenting with migraine and aura to uncover and rectify potential contributory structural heart defects like PFO. After PFO closure, this patient's significant improvement, evidenced by the absence of migraine recurrence, highlights the potential therapeutic benefit of addressing cardiac anomalies in such patients. It is important to note that current evidence does not support PFO closure as a treatment for migraines unless there are findings suggestive of ischemic stroke.
偏头痛是一种常见的原发性头痛疾病，常扰乱日常生活，尤其是当伴有视觉先兆时。尽管偏头痛的病因仍不明确，但越来越多的证据表明其与心血管异常有关。
本病例涉及一名 35 岁女性，患有偏头痛伴先兆。影像学研究，包括 MRI/A，显示右侧额区小血管缺血性损伤和右侧枕区既往微出血。患者的 RoPE 评分为 9 分（高），TEE+bubble 试验后诊断为 4 级（严重）PFO。经股静脉顺行途径，使用 25mm Amplatzer PFO 封堵器，无需透视，成功完成了经皮 PFO 封堵术。患者情况稳定出院，5 个月随访时无偏头痛发作。在年轻偏头痛患者中，尤其是有先兆的患者，检测到 PFO 至关重要，在评估和治疗时需要进行彻底检查。
本病例强调了在年轻个体出现偏头痛和先兆时，将心脏评估纳入诊断方案的重要性，以发现和纠正潜在的结构性心脏病缺陷，如 PFO。在进行 PFO 封堵后，该患者显著改善，偏头痛未再发作，这突出了在这类患者中治疗心脏异常的潜在治疗益处。需要注意的是，目前的证据并不支持 PFO 封堵作为偏头痛的治疗方法，除非有提示缺血性卒中的发现。
