{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:08:27Z","timestamp":1792598907653,"version":"4.5.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Purpose\u2014<\/jats:title>\n                    <jats:p>Individuals 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\u2014<\/jats:title>\n                    <jats:p>Patients 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results\u2014<\/jats:title>\n                    <jats:p>Of 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>In 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.117.020160","type":"journal-article","created":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T05:05:17Z","timestamp":1523336717000},"page":"1123-1128","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":102,"title":["Frequency of Patent Foramen Ovale and Migraine in Patients With Cryptogenic Stroke"],"prefix":"10.1161","volume":"49","author":[{"given":"Brian H.","family":"West","sequence":"first","affiliation":[{"name":"From 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabil","family":"Noureddin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, UNLV School of Medicine, Las Vegas, NV (N.N.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakov","family":"Mamzhi","sequence":"additional","affiliation":[{"name":"From 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Low","sequence":"additional","affiliation":[{"name":"California Northstate University College of Medicine, Elk Grove (C.G.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra C.","family":"Coluzzi","sequence":"additional","affiliation":[{"name":"From 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan J.","family":"Shih","sequence":"additional","affiliation":[{"name":"From 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubine","family":"Gevorgyan Fleming","sequence":"additional","affiliation":[{"name":"From 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Saver","sequence":"additional","affiliation":[{"name":"UCLA Department of Neurology, Los Angeles, CA (J.L.S., D.S.L., A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Liebeskind","sequence":"additional","affiliation":[{"name":"UCLA Department of Neurology, Los Angeles, CA (J.L.S., D.S.L., A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Charles","sequence":"additional","affiliation":[{"name":"UCLA Department of Neurology, Los Angeles, CA (J.L.S., D.S.L., A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan M.","family":"Tobis","sequence":"additional","affiliation":[{"name":"From 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.)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2009.12.021"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.488395"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38302.504063.8F"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.310.6983.830"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.03.070"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1953.02320350003001"},{"key":"e_1_3_4_8_2","first-page":"283","article-title":"Cerebral vasospasm in migraine.","volume":"87","author":"Dalessio DJ","year":"1967","unstructured":"Dalessio DJ. 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