A retrospective review of clopidogrel as primary therapy for migraineurs with right to left shunt lesions

Barbara T. Spencer, Yasir Qureshi, Robert J. Sommer

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: The association of patient foramen ovale (PFO) and migraine headache (migraine) with aura (MA) is well established. Current research suggests a mechanistic link between platelet activation, paradoxical embolization and migraine in some patients. Methods: Clopidogrel, a platelet inhibitor, was added to existing migraine therapy, as a 4-week open-label trial in 15 women, aged 16-56 years, with severe migraine and documented right to left shunt (RLS). Results: 13/15 had >50% reduction or complete elimination of migraine symptoms. After completing the trial period, five responders remain on clopidogrel with ongoing benefit at 11.9 ± 4.5 months (6.5-20), one stopped clopidogrel because of side effects. Nine other responders underwent PFO closure and clopidogrel discontinuation. Eight of nine have had ongoing benefit. Conclusions: Clopidogrel may have a primary prophylactic role in migraine/RLS patients, but may also help select candidates who would benefit from PFO closure. A randomized clinical trial is being established.

Original languageEnglish
Pages (from-to)933-937
Number of pages5
JournalCephalalgia
Volume34
Issue number11
DOIs
StatePublished - 12 Oct 2014
Externally publishedYes

Keywords

  • Clopidogrel
  • Migraine headache
  • Patent foramen ovale

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