Evidence map›Paper›PMID 29636424›Full record

ArticleStroke2018

Frequency of Patent Foramen Ovale and Migraine in Patients With Cryptogenic Stroke.

Brian H West, Nabil Noureddin, Yakov Mamzhi, Christopher G Low, Alexandra C Coluzzi, Evan J Shih, Rubine Gevorgyan Fleming, Jeffrey L Saver, David S Liebeskind, Andrew Charles and 1 more

Registry-linked trialOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Stroke, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07349004 (Association Between PFO and Migraine With Aura), which is not on this map. Cited by 44 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
44citing papers in PubMed, 1 pooled it
9.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07349004 recruitingnot on this mapstarted 2025, after this paper: background citation

Association Between PFO and Migraine With Aura: A Case-Control Observational Study With Genetic and Neurosonological Analysis

TypeobservationalSponsorAzienda Usl di BolognaRan2025 to 2028Enrolled240ConditionsMigraine With AuraArmsIntervention
3 · Its place in the literature

Who cites it

44 citing papers in PubMed, 1 synthesis or guideline pooled it, 113 citations in OpenAlex.

  1. Pooled it
  2. Observational
  3. Review
  4. Article
  5. Review
  6. Article
  7. Review
  8. Article
  9. Review
  10. Article
  11. Review
  12. Review
  13. Review
  14. Article
  15. Neurite Damage in Patients with Migraine.Neurology international · 2024
    Article
  16. Review
  17. Atrial Septal Abnormalities and Cryptogenic Stroke: A Cross-Sectional Study.Cardiovascular & hematological disorders drug targets · 2024
    Article
  18. Article
  19. Article
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 1 country.

Brian H WestFrom the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.).
Nabil NoureddinDepartment of Internal Medicine, UNLV School of Medicine, Las Vegas, NV (N.N.).
Yakov MamzhiFrom the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.).
Christopher G LowCalifornia Northstate University College of Medicine, Elk Grove (C.G.L.).
Alexandra C ColuzziFrom the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.).
Evan J ShihFrom the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.).
Rubine Gevorgyan FlemingFrom the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.).
Jeffrey L SaverUCLA Department of Neurology, Los Angeles, CA (J.L.S., D.S.L., A.C.).
David S LiebeskindUCLA Department of Neurology, Los Angeles, CA (J.L.S., D.S.L., A.C.).
Andrew CharlesUCLA Department of Neurology, Los Angeles, CA (J.L.S., D.S.L., A.C.).
Jonathan M TobisFrom the Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.H.W., Y.M., A.C.C., E.J.S., R.G.F., J.M.T.) jtobis@mednet.ucla.edu.
University of California, Los Angeles · USCalifornia Northstate University · USUniversity of Nevada, Las Vegas · US

Funding

CARDIOVASCULAR SCIENTIST TRAINING PROGRAMT32HL007895 · NHLBI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SHIVKUMAR, KALYANAM, WATSON, KAROL E · 1998 to 2023
$9.2M
NHLBI NIH HHS T32 HL007895
6 · The paper itself

Abstract

background and purposeIndividuals with migraine are at higher risk for stroke, but the mechanism has not been established. On the basis of the association between migraine and intracardiac right-to-left shunt, it has been proposed that stroke in migraineurs could be caused by a paradoxical embolus passing through a patent foramen ovale (PFO) or pulmonary arteriovenous malformation. The aim of this study was to determine the prevalence of PFO with right-to-left shunt in patients who presented with cryptogenic stroke and had a history of migraine.

methodsPatients between 18 and 60 years old who presented with an ischemic stroke were characterized based on ASCOD phenotyping (atherosclerosis; small-vessel disease; cardiac pathology; other causes; dissection). A migraine diagnosis was identified by reviewing physician notes, and frequent aura was defined if present in at least 50% of attacks. A PFO with right-to-left shunt diagnosis was identified by the presence of a positive bubble contrast study with either transcranial Doppler, transthoracic, or transesophageal echocardiography.

resultsOf the 712 patients who presented with ischemic stroke, 127 (18%) were diagnosed as cryptogenic; 68 patients had adequate testing for PFO and a documented migraine history. The prevalence of PFO in patients with cryptogenic stroke without migraine was elevated (59%) compared with the general population (18%). Patients with both cryptogenic stroke and migraine had a higher prevalence of PFO (79%). In patients with cryptogenic stroke who had migraine with frequent aura, the prevalence of PFO was 93%. Only 5 patients (4%) had a history compatible with migrainous infarction.

conclusionsIn patients with cryptogenic stroke who have migraine, there is a high prevalence (79%) of PFO with right-to-left shunt. The timing of the stroke in migraineurs is usually not related to a migraine attack. These observations are consistent with the hypothesis that the mechanism of stroke in migraineurs is most likely because of a paradoxical embolus. Future cryptogenic stroke classification schemes should consider including PFO as a separate etiologic category.

Indexed as

AdolescentAdultEchocardiography, TransesophagealFemaleForamen Ovale, PatentHumansMaleMiddle AgedMigraine DisordersPrevalenceStrokeUltrasonography, Doppler, TranscranialYoung Adultcryptogenic strokemigrainepatent foramen ovale

Identifiers

PMID29636424
PMCPMC5915909
OpenAlexW2798206433

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.