Tabla I. Descripción de las principales variables demográficas. |
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Todas |
Con lesiones de la sustancia blanca |
Sin lesiones de la sustancia blanca |
p |
|
Edad (años) a |
42,7 ± 11,8 |
35,6 ± 11,9 |
46,8 ± 9,7 |
< 0,001 |
Hipertensión |
10 (11,2%) |
2 (6,1%) |
8 (14,3%) |
0,40 |
Dislipidemia |
17 (19,1%) |
6 (18,2%) |
11 (19,6%) |
1,00 |
Diabetes |
3 (3,4%) |
1 (3%) |
2 (3,6%) |
1,00 |
Tabaquismo |
11 (12,4%) |
2 (6,1 %) |
9 (16,1%) |
0,29 |
Abuso de analgésicos |
30 (33,7%) |
10 (30,3%) |
20 (35,7%) |
0,77 |
AINE |
64 (71,9%) |
25 (75,8%) |
39 (69,6%) |
0,70 |
Triptanes |
61 (68,5%) |
20 (60,6%) |
41 (73,2%) |
0,31 |
Opioides |
10 (11,2%) |
4 (12,1%) |
6 (10,7%) |
1,00 |
Betabloqueantes |
24 (27%) |
8 (24,2%) |
16 (28,6%) |
0,84 |
Amitriptilina |
24 (27%) |
10 (30,3%) |
14 (25%) |
0,76 |
IAC |
54 (64%) |
23 (69,7%) |
34 (60,7%) |
0,53 |
Ácido valproico |
5 (5,6%) |
2 (6,1%) |
3 (5,4%) |
1,00 |
IECA |
14 (15,7%) |
3 (9,1%) |
11 (19,6%) |
0,17 |
ISRS |
10 (11,2%) |
2 (6,1%) |
8 (14,3%) |
0,40 |
Aura |
45 (50,6%) |
17 (51,5%) |
28 (50%) |
1,00 |
AINE: antiinflamatorios no esteroideos; IAC: inhibidores de la anhidrasa carbónica; IECA: inhibidores de la enzima conversora de la angiotensina; ISRS: inhibidores selectivos de la recaptación de la serotonina. a Media ± desviación estándar. |
Tabla II. Prevalencia y características del foramen oval permeable en la migraña crónica con y sin lesiones de la sustancia blanca. |
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Con lesiones de la sustancia blanca |
Sin lesiones de la sustancia blanca |
p |
||
Foramen oval permeable |
30 (53,6%) |
16 (48,5%) |
0,80 |
|
Tamaño |
Masivo |
13 (23,2%) |
4 (12,1%) |
0,31 |
Moderado |
6 (10,7%) |
7 (21,2%) |
0,29 |
|
Pequeño |
11 (19,6%) |
5 (15,2%) |
0,80 |
|
Detección |
Permanente |
13 (23,2%) |
6 (18,2%) |
0,77 |
Latente |
17 (30,4%) |
10 (30,3%) |
1,00 |
Tabla III. Prevalencia y características del foramen oval permeable en función de la localización de las lesiones de la sustancia blanca. |
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Lesiones en la sustancia blanca |
p |
||||||
Profundas |
Periventriculares + profundas |
||||||
Foramen oval permeable |
20 (55,6%) |
10 (52,6%) |
1,00 |
||||
Tamaño |
Masivo |
8 (22,2%) |
5 (26,3%) |
0,99 |
|||
Moderado |
4 (11,1%) |
2 (10,5%) |
1,00 |
||||
Pequeño |
8 (22,2%) |
3 (15,8%) |
0,83 |
||||
Detección |
Permanente |
6 (16,7%) |
7 (36,8%) |
0,18 |
|||
Latente |
14 (38,9%) |
3 (15,8%) |
0,14 |
Is there a relationship between white matter lesions associated with migraine and patent foramen ovale? Analysis of a series of patients with chronic migraine Introduction. White matter lesions are more prevalent in migraine patients than in the general population, especially those with a high frequency of attacks. A patent foramen ovale has been described as a possible link between migraine and white matter lesions. Aim. To determine the existence of a possible relationship between a patent foramen ovale and white matter lesions in a series of patients with chronic migraine. Patients and methods. Observational, single-centre, case-control study. Eighty-nine women with chronic migraine were selected. The persistence and characteristics of the patent foramen ovale were assessed by means of a transcranial Doppler study. The patent foramen ovale was classified as small, moderate or massive. Those detected at rest were considered permanent, and the others were classified as latent. The MRI protocol included T1-enhanced sagittal images, FLAIR-T2-enhanced axial images, and a proton density and T2-FSE combined sequence. The white matter lesions were classified as deep, periventricular or both. Results. The prevalence of patent foramen ovale (53.6% versus 48.5%; p = 0.80) and the proportion of massive, permanent patent foramen ovale were similar among patients with and without white matter lesions. Neither was there any difference in the prevalence (55.6% versus 52.6%; p = 1.00) or the characteristics of the patent foramen ovale as a function of the distribution of white matter lesions. Conclusion. The results do not suggest that a patent foramen ovale intervenes in the pathophysiology of the white matter lesions observed in patients with migraine. Key words. Magnetic resonance. Migraine. Paradoxical embolism. Patent foramen ovale. Transcranial Doppler ultrasonography. White matter lesions. |