neurojourНеврологический журнал имени Л.О. БадалянаL.O. Badalyan Neurological Journal2686-89972712-794XФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/2686-8997-2022-3-3-114-121neurojour-71Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSРоль ультразвукового исследования артерий головы и шеи в диагностике мигрениThe role of the cerebral and cervical arteries ultrasound examination in migraine diagnosishttps://orcid.org/0000-0002-6673-5961ТардовМихаил ВладимировичTardovMikhail V.

Доктор мед. наук, проф. кафедры общей врачебной практики ФГАОУ ВО РУДН, 117198, Москва.

e-mail: mvtardov@rambler.ru

MD, PhD, DSci., Professor of the Department of general medical practice, Peoples’ Friendship University of Russia, Moscow, 117198, Russian Federation.

e-mail: mvtardov@rambler.ru

mvtardov@rambler.ruhttps://orcid.org/0000-0001-9319-2061БолдинА. В.BoldinAlexei V.noemail@neicon.ruhttps://orcid.org/0000-0001-8549-0106РазумовА. Н.RazumovAleksandr N.noemail@neicon.ruФГАОУ ВО «Российский университет дружбы народов»Peoples’ Friendship University of RussiaФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)I.M. Sechenov First Moscow State Medical University20221810202233114121Copyright © Тардов М.В., Болдин А.В., Разумов А.Н., 20222022Тардов М.В., Болдин А.В., Разумов А.Н.Tardov M.V., Boldin A.V., Razumov A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.neuro-journal.ru/jour/article/view/71

Мигрень как первичное заболевание является весьма распространённой проблемой. Однако приступы головной боли, имитирующие приступы мигрени, нередко могут быть вторичными, обусловленными различными видами патологии сосудов шеи и головного мозга. Могут быть поражены общие или внутренние сонные артерии, позвоночные артерии, передние, средние и задние мозговые артерии, передняя и задняя соединительные артерии или основная артерия. Выявление таких заболеваний — первоочередная задача дифференциальной диагностики мигрени, особенно мигрени с аурой, и вторичных цефалгических синдромов, поскольку в ряде случаев речь идет об опасных для жизни состояниях, требующих немедленного вмешательства: разрыв аневризмы артерии основания головного мозга или артериовенозной мальформации, диссекция одной или нескольких шейных артерий. Для диагностики заболеваний сосудов с успехом применяются различные виды ультразвукового исследования, начиная от «слепой» допплерографии и заканчивая трехмерной реконструкцией сосудов и контрастных ультразвуковых исследований. Дефект овального окна может осложняться парадоксальными микроэмболиями, которые способны приводить к нарушению мозгового кровообращения. Данная анатомическая особенность также доступна диагностике с помощью ультразвука. Хирургическое закрытие дефекта овального окна снижает не только частоту приступов мигрени с аурой, но и риск инсульта. В обзорной статье рассмотрены клинико-диагностические аспекты аневризм сосудов головного мозга и артериовенозных мальформаций, расслоения стенки брахиоцефальных артерий. Обсуждается диагностика микроэмболий церебральных артерий, обусловленных парадоксальным перемещением материальных эмболов при незаращении овального окна как причины одного из самых грозных осложнений мигрени — инсульта.

Участие авторов

Участие авторов:Тардов М.В. — концепция; написание текста;Болдин А.В. — концепция, редактирование текста;Разумов А.Н. — концепция, редактирование текста;Все соавторы — утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи.

Финансирование

Финансирование. Исследование не имело спонсорской поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 24

Поступила 24.06.2022Принята к печати 26.08.2022Опубликована 30.09.2022

Migraine as a primary disease is a very common problem. However, headache attacks that mimic migraine attacks can often be secondary, due to various type of pathology of cervical and cerebral vessels. The common or internal carotid arteries, vertebral arteries, and the anterior, middle, and posterior cerebral arteries, the anterior and posterior communicating arteries, or the basilar artery may be affected. Identification of such diseases is the primary task of differential diagnosis in migraine, especially migraine with aura, and secondary cephalgic syndromes, since in some cases we are talking about life-threatening conditions that require immediate intervention: rupture of brain artery aneurysm or arteriovenous malformation, dissection of one or more cervical arteries. Various types of ultrasound are successfully used to diagnose vascular diseases, ranging from “blind” dopplerography to three-dimensional reconstruction of blood vessels and contrast ultrasound. The defect of the oval window can be complicated by paradoxical microembolism, that can lead to impaired cerebral circulation. This anatomical feature is also available for diagnosis using ultrasound; and once the diagnosis is established, surgical closure of the foramen ovale defect reduces not only the prevalence of migraine with aura attacks, but also the risk of the stroke. This review article discusses the clinical and diagnostic aspects of cerebral aneurysms and arteriovenous malformations, dissection of brachiocephalic arteries’ wall. It also discusses the diagnosis of cerebral arteries’ microembolism, caused by the paradoxical movement of material emboli through non-closure of the foramen ovale, as the cause of one of the most formidable complications of migraine — stroke.

Contribution

Contribution:Tardov M.V. — concept, writing text;Boldin A.V. — concept, editing;Razumov A.N. — concept, editing.All co-authors — approval of the final version of the manuscript, responsibility for the integrity of all parts of the manuscript.

Acknowledgment

Acknowledgment. The study had no sponsorship.

Conflict of interest

Conflict of interest. The authors declare no conflict of interest.

Received

Received: June 24, 2022Accepted: July 27, 2022Published: September 30, 2022

мигреньаневризмаартерио-венозная мальформациямикроэмболиядефект овального окнаmigraineaneurysmarteriovenous malformationmicroembolismoval window defectReferencesWillis T., Pordage S. Two Discourses Concerning the Soul of Brutes, which Is that of the Vital and Sensitive of Man: The First Is Physiological, Shewing the Nature, Parts, Powers, And Affections Of The Same; And The Other Is Pathological, Which Unfolds the Diseases Which Affect It and Its Primary Seat, to Wit, the Brain and Nervous Stock, and Treats of Their Cures: With Copper Cuts. London: Dring, Harper and Leigh; 1683.Willis T., Pordage S. Two Discourses Concerning the Soul of Brutes, which Is that of the Vital and Sensitive of Man: The First Is Physiolo­gical, Shewing the Nature, Parts, Powers, And Affections Of The Same; And The Other Is Pathological, Which Unfolds the Diseases Which Affect It and Its Primary Seat, to Wit, the Brain and Nervous Stock, and Treats of Their Cures: With Copper Cuts. London: Dring, Harper and Leigh; 1683.Wolff H.G. Headache and Other Head Pains. New York: Oxford University Press; 1963.Wolff H.G. Headache and Other Head Pains. New York: Oxford University Press; 1963.Leao A.A. Spreading depression of activity in the cerebral cortex. J. Neurophysiology. 1944; 7(6): 359-90.Leao A.A. Spreading depression of activity in the cerebral cortex. J. Neurophysiology. 1944; 7(6): 359–90.Abernathy M., Donnelly G., Kay G., Wieneke J., Morris S., Bergeson S., et al. Transcranial Doppler sonography in headache-free migraineurs. Headache. 1994; 34(4): 198-203. https://doi.org/10.1111/j.1526-4610.1994.hed3404198.xAbernathy M., Donnelly G., Kay G., Wieneke J., Morris S., Bergeson S., et al. Transcranial Doppler sonography in headache-free migraineurs. Headache. 1994; 34(4): 198–203. https://doi.org/10.1111/j.1526-4610.1994.hed3404198.xAnzola G., Magoni M., Guindani M., Rozzini L., Dalla Volta G. Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology. 1999; 52(8): 1622-5. https://doi.org/10.1212/wnl.52.8.1622Anzola G., Magoni M., Guindani M., Rozzini L., Dalla Volta G. Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology. 1999; 52(8): 1622–5. https://doi.org/10.1212/wnl.52.8.1622Caekebeke J., Ferrari M., Zwetsloot C., Jansen J., Saxena P. Antimigraine drug sumatriptan increases blood flow velocity in large cerebral arteries during migraine attacks. Neurology. 1992; 42(8): 1522-6. https://doi.org/10.1212/wnl.42.8.1522Caekebeke J., Ferrari M., Zwetsloot C., Jansen J., Saxena P. Antimigraine drug sumatriptan increases blood flow velocity in large cerebral arteries during migraine attacks. Neurology. 1992; 42(8): 1522–6. https://doi.org/10.1212/wnl.42.8.1522Fiermonte G., Pierelli F., Pauri F., Cosentino F., Soccorsi R., Giacomini P. Cerebrovascular CO2 reactivity in migraine with aura and without aura. A transcranial Doppler study. Acta Neurol. Scand. 1995; 92(2): 166-9. https://doi.org/10.1111/j.1600-0404.1995.tb01033.xFiermonte G., Pierelli F., Pauri F., Cosentino F., Soccorsi R., Giacomini P. Cerebrovascular CO2 reactivity in migraine with aura and without aura. A transcranial Doppler study. Acta Neurol. Scand. 1995; 92(2): 166–9. https://doi.org/10.1111/j.1600-0404.1995.tb01033.xHarer C., von Kummer R. Cerebrovascular CO2 reactivity in migraine: assessment by transcranial Doppler ultrasound. J. Neurol. 1991; 238(1): 23-6. https://doi.org/10.1007/bf00319705Harer C., von Kummer R. Cerebrovascular CO2 reactivity in migraine: assessment by transcranial Doppler ultrasound. J. Neurol. 1991; 238(1): 23–6. https://doi.org/10.1007/bf00319705Heckmann J., Hilz M., Katalinic A., Marthol H., Muck-Weymann M., Neundorfer B. Myogenic cerebrovascular autoregulation in migraine measured by stress transcranial Doppler sonography. Cephalalgia. 1998; 18(3): 133-7. https://doi.org/10.1046/j.1468-2982.1998.1803133.xHeckmann J., Hilz M., Katalinic A., Marthol H., Muck-Weymann M., Neundorfer B. Myogenic cerebrovascular autoregulation in migraine measured by stress transcranial Doppler sonography. Cephalalgia. 1998; 18(3): 133–7. https://doi.org/10.1046/j.1468-2982.1998.1803133.xSilvestrini M., Cupini L., Troisi E., Matteis M., Bernardi G. Estimation of cerebrovascular reactivity in migraine without aura. Stroke. 1995; 26(1): 81-3. https://doi.org/10.1161/01.str.26.1.81Silvestrini M., Cupini L., Troisi E., Matteis M., Bernardi G. Estimation of cerebrovascular reactivity in migraine without aura. Stroke. 1995; 26(1): 81–3. https://doi.org/10.1161/01.str.26.1.81Thomsen L., Iversen H., Brinck T., Olesen J. Arterial supersensitivity to nitric oxide (nitroglycerin) in migraine sufferers. Cephalalgia. 1993; 13(6): 395-9. https://doi.org/10.1046/j.1468-2982.1993.1306395.xThomsen L., Iversen H., Brinck T., Olesen J. Arterial supersensitivity to nitric oxide (nitroglycerin) in migraine sufferers. Cephalalgia. 1993; 13(6): 395–9. https://doi.org/10.1046/j.1468-2982.1993.1306395.xNarbone M., Rao R., Grugno R., Pellicanò M. A late ‘migraine’: the only symptom of an intrasellar aneurysm. Headache. 1997; 37(8): 527-8. https://doi.org/10.1046/j.1526-4610.1997.3708527.xNarbone M., Rao R., Grugno R., Pellicanò M. A late ‘migraine’: the only symptom of an intrasellar aneurysm. Headache. 1997; 37(8): 527–8. https://doi.org/10.1046/j.1526-4610.1997.3708527.xPierelli F., Pauri F., Cupini L., Fiermonte G., Rizzo P. Transcranial Doppler sonography in familial hemiplegic migraine. Cephalalgia. 1991; 11(1): 29-31. https://doi.org/10.1046/j.1468-2982.1991.1101029.xPierelli F., Pauri F., Cupini L., Fiermonte G., Rizzo P. Transcranial Doppler sonography in familial hemiplegic migraine. Cephalalgia. 1991; 11(1): 29–31. https://doi.org/10.1046/j.1468-2982.1991.1101029.xАзимова Ю.Э., Амелин А.В., Алферова В.В., Артеменко А.Р., Ахмадеева Л.Р., Головачева В.А. и др. Клинические рекомендации «Мигрень». Журнал неврологии и психиатрии им. С.С. Корсакова. 2022; 122(1-3): 4-36. https://doi.org/10.17116/jnevro20221220134Azimova Yu.E., Amelin A.V., Alferova V.V., Artemenko A.R., Akhmadeeva L.R., Golovacheva V.A., et al. Clinical guidelines «Migraine». Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2022; 122(1‑3): 4–36. https://doi.org/10.17116/jnevro20221220134 (in Russian)Zwetsloot C., Caekebeke J., Ferrari M. Lack of asymmetry of middle cerebral artery blood velocity in unilateral migraine. Stroke. 1993; 24(9): 1335-8. https://doi.org/10.1161/01.str.24.9.1335Zwetsloot C., Caekebeke J., Ferrari M. Lack of asymmetry of middle cerebral artery blood velocity in unilateral migraine. Stroke. 1993; 24(9): 1335–8. https://doi.org/10.1161/01.str.24.9.1335Benndorf G., Naeini R., Lehmann T. Triple carotid aneurysms in a patient with migraine attacks. J. Neurol. Neurosurg. Psychiatry. 2004; 75(7): 993. https://doi.org/10.1136/jnnp.2004.037168Benndorf G., Naeini R., Lehmann T. Triple carotid aneurysms in a patient with migraine attacks. J. Neurol. Neurosurg. Psychiatry. 2004; 75(7): 993. https://doi.org/10.1136/jnnp.2004.037168de Filippis S., Salvatori E., Bozzao A., Fantozzi L., Martelletti P. Migraine with aura, bipolar depression, ACM aneurysm. A case report. J. Headache Pain. 2005; 6(2): 93-6. https://doi.org/10.1007/s10194-005-0159-0de Filippis S., Salvatori E., Bozzao A., Fantozzi L., Martelletti P. Migraine with aura, bipolar depression, ACM aneurysm. A case report. J. Headache Pain. 2005; 6(2): 93–6. https://doi.org/10.1007/s10194-005-0159-0Pico F., Biousse V., Chapot R., Bousser M.G. Aneurysm of the anterior cerebral artery disclosed by unique hemianopic scotoma. Rev. Neurol. (Paris). 2002; 158(3): 347-50. (in French)Pico F., Biousse V., Chapot R., Bousser M.G. Aneurysm of the anterior cerebral artery disclosed by unique hemianopic scotoma. Rev. Neurol. (Paris). 2002; 158(3): 347–50. (in French)Lee H.S., Kim M., Park J.C., Ahn J.S., Lee S., Park W. Clinical features of ischemic complications after unruptured middle cerebral artery aneurysm clipping: patients and radiologically related factors. Neurosurg. Rev. 2021; 44(5): 2819-29. https://doi.org/10.1007/s10143-021-01475-8Lee H.S., Kim M., Park J.C., Ahn J.S., Lee S., Park W. Clinical features of ischemic complications after unruptured middle cerebral artery aneurysm clipping: patients and radiologically related factors. Neurosurg. Rev. 2021; 44(5): 2819–29. https://doi.org/10.1007/s10143-021-01475-8Kojo N., Lee S., Otsuru K., Takagi S., Shigemori M., Watanabe M. A case of ophthalmoplegic migraine with cerebral aneurysm. No Shinkei Geka. 1988; 16(5 Suppl.): 503-7.Kojo N., Lee S., Otsuru K., Takagi S., Shigemori M., Watanabe M. A case of ophthalmoplegic migraine with cerebral aneurysm. No Shinkei Geka. 1988; 16(5 Suppl.): 503–7.Mas J., Baron J., Bousser M., Chiras J. Stroke, migraine and intracranial aneurysm: a case report. Stroke. 1986; 17(5): 1019-21. https://doi.org/10.1161/01.str.17.5.1019Mas J., Baron J., Bousser M., Chiras J. Stroke, migraine and intracranial aneurysm: a case report. Stroke. 1986; 17(5): 1019–21. https://doi.org/10.1161/01.str.17.5.1019Morelli N., Mancuso M., Gori S., Maluccio M., Cafforio G., Chiti A., et al. Vertebral artery dissection onset mimics migraine with aura in a graphic designer. Headache. 2008; 48(4): 621-624. https://doi.org/10.1111/j.1526-4610.2008.01066.xMorelli N., Mancuso M., Gori S., Maluccio M., Cafforio G., Chiti A., et al. Vertebral artery dissection onset mimics migraine with aura in a graphic designer. Headache. 2008; 48(4): 621–624. https://doi.org/10.1111/j.1526-4610.2008.01066.xMonteiro J., Rosas M., Correia A., Vaz A. Migraine and intracranial vascular malformations. Headache. 1993; 33(10): 563-5. https://doi.org/10.1111/j.1526-4610.1993.hed3310563.xMonteiro J., Rosas M., Correia A., Vaz A. Migraine and intracranial vascular malformations. Headache. 1993; 33(10): 563–5. https://doi.org/10.1111/j.1526-4610.1993.hed3310563.xNagata S., Morioka T., Natori Y., Sasaki T. Surgical treatment of non-ruptured giant occipital arteriovenous malformations with frequent migraine-like headache. Neurol. Med. Chir. (Tokyo). 2006; 46(9): 441-5. https://doi.org/10.2176/nmc.46.441Nagata S., Morioka T., Natori Y., Sasaki T. Surgical treatment of non-ruptured giant occipital arteriovenous malformations with frequent migraine-like headache. Neurol. Med. Chir. (Tokyo). 2006; 46(9): 441–5. https://doi.org/10.2176/nmc.46.441Bruyn G.W.Intracranial arteriovenous malformation and migraine. Cephalalgia. 1984; 4(3): 191-207. https://doi.org/10.1046/j.1468-2982.1984.0403191.xBruyn G.W. Intracranial arteriovenous malformation and migraine. Cephalalgia. 1984; 4(3): 191–207. https://doi.org/10.1046/j.1468-2982.1984.0403191.xBiousser V., D’Anglejan-Chatillon J., Massiou H., Bousser M. Head pain in non-traumatic carotid artery dissection: a series of 65 patients. Cephalalgia. 1994; 14(1): 3. https://doi.org/10.1046/j.1468-2982.1994.1401033.xBiousser V., D’Anglejan-Chatillon J., Massiou H., Bousser M. Head pain in non-traumatic carotid artery dissection: a series of 65 patients. Cephalalgia. 1994; 14(1): 3. https://doi.org/10.1046/j.1468-2982.1994.1401033.xGuillon B., Bousser M. Epidemiology and pathophysiology of spontaneous cervical artery dissection. J. Neuroradiol. 2002; 29(4): 241-9. (in French)Guillon B., Bousser M. Epidemiology and pathophysiology of spontaneous cervical artery dissection. J. Neuroradiol. 2002; 29(4): 241–9. (in French)Shanmugalingam R., Reza Pour N., Chuah S.C., Vo T.M., Beran R., Hennessy A., et al. Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review. BMC Pregnancy Childbirth. 2016; 16(1): 164. https://doi.org/10.1186/s12884-016-0953-5Shanmugalingam R., Reza Pour N., Chuah S.C., Vo T.M., Beran R., Hennessy A., et al. Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review. BMC Pregnancy Childbirth. 2016; 16(1): 164. https://doi.org/10.1186/s12884-016-0953-5Ramadan N., Tietjen G., Levine S., Welch K. Scintillating scotomata associated with internal carotid artery dissection: report of three cases. Neurology. 1991; 41(7): 1084-7. https://doi.org/10.1212/wnl.41.7.1084Ramadan N., Tietjen G., Levine S., Welch K. Scintillating scotomata associated with internal carotid artery dissection: report of three cases. Neurology. 1991; 41(7): 1084–7. https://doi.org/10.1212/wnl.41.7.1084d’Anglejan Chatillon J., Ribeiro V., Mas J.L., Bousser M.G., Laplane D. Dissection of the extracranial internal carotid artery. 62 cases. Presse Med. 1990; 19(14): 661-7. (in French)d’Anglejan Chatillon J., Ribeiro V., Mas J.L., Bousser M.G., Laplane D. Dissection of the extracranial internal carotid artery. 62 cases. Presse Med. 1990; 19(14): 661–7. (in French)Metso T., Metso A., Salonen O., Haapaniemi E., Putaala J., Artto V., et al. Adult cervicocerebral artery dissection: a single-center study of 301 Finnish patients. Eur. J. Neurol. 2009; 16(6): 656-61. https://doi.org/10.1111/j.1468-1331.2009.02535.xMetso T., Metso A., Salonen O., Haapaniemi E., Putaala J., Artto V., et al. Adult cervicocerebral artery dissection: a single-center study of 301 Finnish patients. Eur. J. Neurol. 2009; 16(6): 656–61. https://doi.org/10.1111/j.1468-1331.2009.02535.xArnold M., De Marchis G., Stapf C., Baumgartner R., Nedeltchev K., Buffon F., et al. Triple and quadruple spontaneous cervical artery dissection: presenting characteristics and long-term outcome. J. Neurol. Neurosurg. Psychiatry. 2009; 80(2): 171-4. https://doi.org/10.1136/jnnp.2008.155226Arnold M., De Marchis G., Stapf C., Baumgartner R., Nedeltchev K., Buffon F., et al. Triple and quadruple spontaneous cervical artery dissection: presenting characteristics and long-term outcome. J. Neurol. Neurosurg. Psychiatry. 2009; 80(2): 171–4. https://doi.org/10.1136/jnnp.2008.155226Campbell-Lloyd A.J., Kanagalingam J., Bandi H., Coman S. Vertebral artery dissection after direct laryngoscopy: case report and literature review. J. Laryngol. Otol. 2009; 123(2): e11. https://doi.org/10.1017/s0022215108003940Campbell-Lloyd A.J., Kanagalingam J., Bandi H., Coman S. Vertebral artery dissection after direct laryngoscopy: case report and literature review. J. Laryngol. Otol. 2009; 123(2): e11. https://doi.org/10.1017/s0022215108003940Chaibi A., Russell M.B. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann. Med. 2019; 51(2): 118-27. https://doi.org/10.1080/07853890.2019.1590627Chaibi A., Russell M.B. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann. Med. 2019; 51(2): 118–27. https://doi.org/10.1080/07853890.2019.1590627Harada T., Harada Y., Shimizu T. Vertebral Artery dissection after exposure to levofloxacin: A report of two cases.Intern. Med. 2021; 60(17): 2863-5. https://doi.org/10.2169/internalmedicine.6736-20Harada T., Harada Y., Shimizu T. Vertebral Artery dissection after exposure to levofloxacin: A report of two cases. Intern. Med. 2021; 60(17): 2863–5. https://doi.org/10.2169/internalmedicine.6736-20Yoshimoto Y., Hoya K., Tanaka Y., Uchida T. Basilar artery dissection. J. Neurosurg. 2005; 102(3): 476-81. https://doi.org/10.3171/jns.2005.102.3.0476Yoshimoto Y., Hoya K., Tanaka Y., Uchida T. Basilar artery dissection. J. Neurosurg. 2005; 102(3): 476–81. https://doi.org/10.3171/jns.2005.102.3.0476Arnold M., Bousser M. Clinical manifestations of vertebral artery dissection. Front. Neurol. Neurosci. 2005; 20: 77-86. https://doi.org/10.1159/000088152Arnold M., Bousser M. Clinical manifestations of vertebral artery dissection. Front. Neurol. Neurosci. 2005; 20: 77–86. https://doi.org/10.1159/000088152Bushnell C.D., Jamison M., James A.H. Migraines during pregnancy linked to stroke and vascular diseases: US population based case-control study. BMJ. 2009; 338: b664. https://doi.org/10.1136/bmj.b664Bushnell C.D., Jamison M., James A.H. Migraines during pregnancy linked to stroke and vascular diseases: US population based case-control study. BMJ. 2009; 338: b664. https://doi.org/10.1136/bmj.b664Kurth T., Diener H.C. Current views of the risk of stroke for migraine with and migraine without aura. Curr. Pain Headache. Rep. 2006; 10(3): 214-20. https://doi.org/10.1007/s11916-006-0048-5Kurth T., Diener H.C. Current views of the risk of stroke for migraine with and migraine without aura. Curr. Pain Headache. Rep. 2006; 10(3): 214–20. https://doi.org/10.1007/s11916-006-0048-5Vuković V., Aleksić-Shihabi A., Lovrencić-Huzjan A., Demarin V. Migraine, stroke and patent foramen ovale - connected or not? Acta. Med. Croatica. 2008; 62(2): 197-203. (in Croatian)Vuković V., Aleksić-Shihabi A., Lovrencić-Huzjan A., Demarin V. Migraine, stroke and patent foramen ovale – connected or not? Acta. Med. Croatica. 2008; 62(2): 197–203. (in Croatian)Trabattoni D., Fabbiocchi F., Montorsi P., Galli S., Teruzzi G., Grancini L., et al. Sustained long-term benefit of patent foramen ovale closure on migraine. Catheter. Cardiovasc.Interv. 2011; 77(4): 570-4. https://doi.org/10.1002/ccd.22826Trabattoni D., Fabbiocchi F., Montorsi P., Galli S., Teruzzi G., Grancini L., et al. Sustained long-term benefit of patent foramen ovale closure on migraine. Catheter. Cardiovasc. Interv. 2011; 77(4): 570–4. https://doi.org/10.1002/ccd.22826Wahl A., Praz F., Tai T., Findling O., Walpoth N., Nedeltchev K., et al. Improvement of migraine headaches after percutaneous closure of patent foramen ovale for secondary prevention of paradoxical embolism. Heart. 2010; 96(12): 967-73. https://doi.org/10.1136/hrt.2009.181156Wahl A., Praz F., Tai T., Findling O., Walpoth N., Nedeltchev K., et al. Improvement of migraine headaches after percutaneous closure of patent foramen ovale for secondary prevention of paradoxical embolism. Heart. 2010; 96(12): 967–73. https://doi.org/10.1136/hrt.2009.181156Diener H., Peters C., Rudzio M., Noe A., Dichgans J., Haux R., et al. Ergotamine, flunarizine and sumatriptan do not change cerebral blood flow velocity in normal subjects and migraneurs. J. Neurol. 1991; 238(5): 245-50. https://doi.org/10.1007/bf00319734Diener H., Peters C., Rudzio M., Noe A., Dichgans J., Haux R., et al. Ergotamine, flunarizine and sumatriptan do not change cerebral blood flow velocity in normal subjects and migraneurs. J. Neurol. 1991; 238(5): 245–50. https://doi.org/10.1007/bf00319734Anzola G., Magoni M., Guindani M., Rozzini L., Dalla Volta G. Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology. 1999; 52(8): 1622-5.Anzola G., Magoni M., Guindani M., Rozzini L., Dalla Volta G. Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology. 1999; 52(8): 1622–5.Del Sette M., Angeli S., Leandri M., Ferriero G., Bruzzone G., Finocchi C., et al. Migraine with aura and right-to-left shunt on transcranial Doppler: a case-control study. Cerebrovasc. Dis. 1998; 8(6): 327-30. https://doi.org/10.1159/000015875Del Sette M., Angeli S., Leandri M., Ferriero G., Bruzzone G., Finocchi C., et al. Migraine with aura and right-to-left shunt on transcranial Doppler: a case-control study. Cerebrovasc. Dis. 1998; 8(6): 327–30. https://doi.org/10.1159/000015875

The authors declare that there are no conflicts of interest present.