LAUSR

Migraine is the most common neurological disorder, affecting 12% of the adult population. Migraine with aura (MA) accounts for 15% of all migraines and its typical symptoms include temporary visual or sensory of aphasic disturbances that usually strike before clinical migraine symptoms. Migraine auras can be confused with transient ischemic attack (TIA), where there are stroke symptoms passing in a short time. However, patients affected by MA present a higher cerebrovascular risk with respect to general population, in particular for cardioembolic or criptogenetic stroke. This was pointed out by a study [1] with 1.622 migraineurs compared to nonheadache participants: there was a significant association between migraine with visual aura and ischemic stroke (hazard ratio 1.7, 95% confidence interval 1.2–2.6, p = 0.008). This incidence of stroke in patients with MA may be only in part linked to the higher prevalence of patent foramen ovale (PFO) in these patients [2]. Few studies reported controversial findings about the association of MAwith hypercoagulability states (HS), but a study [3] on 154 patients with stroke, of whom 59 with a history of migraine, showed that HS were more frequent in the migraine than in the non-migraine group (38.6 vs. 16.4%, p < 0.01). In the current study, we aim at evaluating the frequency of hypercoagulability state in patients with MA in our Headache Center; moreover, we look at evidencing if there are differences in PFO frequency in patients with MAwith or without HS and, finally, if there are differences in the characteristics of aura between MA patients with or without HS. We retrospectively screened our Center patient files and included MA patients who underwent medical examination at our Headache Center between January 2012 and July 2017 with a complete thrombophilic screening (MTHR C677T and A1298C mutations, factor V mutation, factor II mutation, lupus anticoagulant (LAC) panel, protein C and S dosage). A headache questionnaire was administered to all participants. International Classification of Headache Disorders (ICHD III beta) diagnostic criteria were used to characterize migraine with visual, visual, paresthesic, or aphasic aura. Individuals with non-migraine headaches according to ICHD-3 were excluded from analysis. In a subgroup of these patients, we performed transcranial Doppler (TCD) for PFO screening; we then compared the rate of PFO in patients with and without hypercoagulability states. Further, we examined if a hypercoagulability state could influence frequency, type, and duration of aura. We found 45 MA patients with complete thrombophilic screening: there was only a male subject. The mean age of the study participants was 36 years (range 16–75 years). Of these, 26 patients (57.8%) presented at least one hypercoagulability state; six patients presented 2 contemporary procoagulant factors. The distribution of procoagulant factors was 14 patients with homozygosis for MTHFR C667T (31.1%), 3 patients with heterozygosis for MTHFR A1298C (6.7%), 2 patients with heterozygosis for factor V mutation (4.4%), 1 patient with heterozygosis for factor II mutation (2.2%), 5 patients with LAC positivity (11.1%), and 6 patients with protein C or S deficiency (13.3%). The incidence of MTHFR C677Hom and LAC positivity in our patients looked like the incidence of the same mutation in patient with stroke [3] (MTHFR C677T Hom 21% and LAC positivity 9.7–12.5%). The deficiency of protein C or S in our patients was present in 13.3%, compared with 1% of similar adult population with inherited deficiencies. Out of the 26 patients with procoagulant factors, 19 underwent TCD, and 11 present a PFO (57.9%); of the remaining 19 patients without procoagulant factors, 13 underwent TCD, and 7 present a PFO (53.8%). Both groups * Gianluca Cecchi [email protected]