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What is a migraine?

Migraine is a common disabling primary headache disorder. According to the World

Health Organisation (WHO) in the Global Burden of Disease Survey 2010, migraine was

ranked as the third most prevalent disorder and seventh-highest specific cause of

disability worldwide. It’s high prevalence impacts significantly on the personal and socio-


Migraine Migraine occurs in two principal subtypes, migraine without aura and migraine with aura. One patient may have both. Migraine without aura Adults with this disorder typically describe: • recurrent episodic moderate or severe headaches which: - are often unilateral and/or pulsating - last 4 hours to 3 days - are often associated with nausea and/or vomiting - are aggravated by routine physical activity • during which they limit activity and prefer dark and quiet • with freedom from symptoms between attacks. In children: • attacks may be shorter-lasting • headache is more commonly bilateral and less usually pulsating • gastrointestinal disturbance is more prominent. Other headache disorders Tension-type headache - occurs in attack like episodes - unilateral but often generalised - typically described as pressure or tightness like a vice or tight band around the head, or is felt in the neck - lacks the associated symptom complex of migraine Cluster headache - mostly affects men - strictly one sided with excruciating pain around the eye - recurs frequently, typically once or more daily, commonly at night - is short-lasting, for 15-180 minutes (~30-60 minutes) - other features can include:  red and watering eye, running or blocked nostril, drooping eyelid - can cause marked agitation (the patient, unable to stay in bed, paces the room, even going outdoors). Source: http://www.who.int/mental_health/neurology/who_ehf_aids_head ache.pdf


Migraine with aura

Migraine with aura, often refered to as ‘classical migraine’ affects one third of people with migraine and accounts for 10% of migraine attacks overall. It is characterised by aura preceding headache, consisting of one or more neurological symptoms that develop gradually over >5 minutes and resolve within 60 minutes. A combination of any of the symptoms below characterise migraine with aura. Complete cure of migraine with aura can be achieved based on the criteria set out below.

Vision - visual disturbances in one or both eyes causing

loss of vision, tunnel vision, loss of field of view, jagged

lines, ‘kaleidoscope’, coloured or pixelated appearance.

Speech - inability to say words or talk coherently (aphasia/ dysphasia) Body - numbness, drooping, pins and needles, tingling (paraesthesia) to one side of the face, arm, hands or legs. Some of the subtypes of migraine with aura

Basilar migraine

-often with typical aura and double vision, vertigo, ringing ears or altered gait/ balance.

Hemiplegic migraine

- aura symptoms with weakness or loss of function in arms or legs which can last up to 72 hours. Retinal migraine - visual symptoms + headache. Familial hemiplegic migraine -genetic trait

Aura without headache

- is also referred to as acephalic migraine. Any or all of the above ‘aura’ symptoms can be experienced with out the headache. Patients can often be daignosed as having a TIA or mini-stroke or may even be referred to an Optometrist/ Opthalmologist due to the visual changes and not ever be recognised as a ‘acephalic migraine’.
We place importance on the following criteria when assessing and offering treatment to sufferers of migraine. 1. Life disabling symptoms 2. Migraine with aura - including focal neurology such as temporary blindness, loss of speech, facial or arm weakness ie. stroke like symptoms (often misdiagnosed as a stroke or mini stroke/ TIA) 3. AND/ OR - A history of stroke (a PFO can often transmit clot and debris from the venous to the arterial circulation) 4. And a failure or intolerance to standard anti-migraine medications.

Patients who meet the above criteria and are found to have a moderate or large sized PFO have a 83%

chance of complete migraine with aura cure 3 months after PFO closure. A further 14% of patients had a

greater than 50% reduction in frequency and severity of migraine symptoms. 97% of patients had

complete relief of the neurological ‘aura’ changes.

What is a PFO?