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- Page navigation anchor for Aspirin for prevention of migraine for patients with patent foramen ovale or mitral prolapse?Aspirin for prevention of migraine for patients with patent foramen ovale or mitral prolapse?
This excellent review [1] made no mention of aspirin for prevention of migraine. There are reasons to think it may be effective for this purpose, particularly in two subgroups of migraineurs: those with mitral valve prolapse or patent foramen ovale (PFO).
Migraine is more common in patients with PFO, and there is some evidence that percutaneous closure of PFO may reduce frequency of migraine attacks.[2] Patients with classic migraine are more likely than controls to have mitral valve prolapse: 25% of the migraine group vs 11 % of controls ; Odds Ratio 2.7, 95% confidence limits 1.17 - 6.29.[3] The common thread may be platelet activation and release of intraplatelet serotonin.
Borgdorrf and Tangelder[4] reviewed evidence that release of platelet serotonin and platelet activation by shear stress may be important in migraine. A systematic review of aspirin for migraine prophylaxis reported slight benefit; [5] however it seems likely that patients with migraine and PFO or mitral prolapse may benefit more from aspirin. As both PFO and mitral prolapse are common in migraineurs, this is a hypothesis that would be worth testing. Until such studies are done, a trial of aspirin in patients with migraine and PFO or mitral prolapse would be worthy of consideration.
Competing Interests: None declared.References
- 1. Tzankova V, Becker WJ, Chan TLH. Pharmacologic prevention of migraine. CMAJ. 2023;195(5):E187-E92.
- 2. Zhang Y, Wang H, Liu L. Patent Foramen Ovale Closure for Treating Migraine: A Meta-Analysis. J Interv Cardiol. 2022;2022:6456272.
- 3. Spence JD, Wong DG, Melendez LJ, Nichol PM, Brown JD. Increased prevalence of mitral valve prolapse in patients with migraine. Can Med Assoc J. 1984;131(12):1457-60.
- 4. Borgdorff P, Tangelder GJ. Migraine: possible role of shear-induced platelet aggregation with serotonin release. Headache. 2012;52(8):1298-318.
- 5. Baena CP, D'Amico RC, Slongo H, Brunoni AR, Goulart AC, Bensenor I. The effectiveness of aspirin for migraine prophylaxis: a systematic review. Sao Paulo Med J. 2017;135(1):42-9.
- Page navigation anchor for RE: Pharmacologic prevention of migraineRE: Pharmacologic prevention of migraine
I would like to draw the authors' attention to their omission of a recent review on the use of melatonin to prevent migraine (1). It demonstrated that melatonin had a beneficial prophylactic role in migraine.
As well, melatonin may be an effective but better tolerated alternative to amitriptyline when used for migraine prophylaxis in children (2) and adults (3).Competing Interests: None declared.References
- 1) https://pubmed.ncbi.nlm.nih.gov/36445912/
- 2) https://pubmed.ncbi.nlm.nih.gov/29379562/
- 3) https://pubmed.ncbi.nlm.nih.gov/27165014/