P5348Aspirin versus clopidogrel treatment for refractory migraine with patent foramen oval

Abstract

Abstract Background The association between migraine with aura (MA+) and persistent foramen ovale (PFO), as well as other right-to-left shunts, is described. Observational studies suggested that when a PFO is closed patients who have MA+ are usually improved. Many observational studies have shown that when PFOs are closed in patients who have had a stroke the patients have a high prevalence of migraine before the procedure and ∼80% report that their migraine symptoms were improved after the closure procedure. Migraine with aura is also improved by medical treatment (aspirin, clopidogrel). Purpose To investigate the MA+ reduction effect with the aspirin or clopidogrel in 90 with MA+ with PFO. Methods MA+ patients were screened for PFO by transcranial sonography and echocardiography. Participants with documented right to left shunt (RLS) and ≥12 monthly MA+ days received aspirin or clopidogrel therapy for 60 days. Those with ≥50% reduction in monthly MA+ days were deemed responders and completed 10 additional treatment months. Results The 90 participants had a mean age of 33.2 years and mean MA+ frequency of 16.4 d/mo. A total of 57/80 were female. A total of 66/80 met criteria for episodic MA+, 14/80 for chronic MA+, 59/80 had a moderate–large RLS. 38 of 80 participants (47%) were responders. MA+ reduction continued through 10 treatment months in all responders. MA+ responder rates were not statistically different in participants with episodic or chronic MA+ or with small/larger RLS shunt magnitude, treatment with aspirin or with clopidogrel. All three (8%) patients had aspirin side effects, without serious adverse events. Conclusion Both medications reduced MA +symptoms and participants seemed to have less MA+ and only small amount had side effects with aspirin. Acknowledgement/Funding None