Migraine in Patients Undergoing PFO Closure: Characterization of a Platelet-Associated Pathophysiological Mechanism: The LEARNER Study

Abstract

The association between migraine and patent foramen ovale (PFO) has been documented. We aimed to investigate platelet activation, prothrombotic phenotype, and oxidative stress status of migraineurs with PFO on 100 mg/day aspirin, before and 6 months after PFO closure. Data show that, before PFO closure, expression of the classical platelet activation markers is comparable in patients and aspirin-treated healthy subjects. Conversely, MHA-PFO patients display an increased prothrombotic phenotype (higher tissue factor^pos platelets and microvesicles and thrombin-generation potential), sustained by an altered oxidative stress status. This phenotype, which is more controlled by P2Y₁₂-blockade than by aspirin, reverted after PFO closure together with a complete migraine remission. (pLatelEts And MigRaine iN patEnt foRamen Ovale [LEARNER]; NCT03521193).

Keywords: GSH, reduced glutathione; GSSG, oxidized glutathione; HS, healthy subject(s); MHA, migraine headache with aura; MV, microvesicles; NAC, N-acetylcysteine; PFO, patent foramen ovale; PS, phosphatidylserine; ROS, reactive oxygen species; TF, tissue factor; WB, whole blood; cTTE, contrast transthoracic echocardiography; migraine with aura; oxidative stress; patent foramen ovale; platelets; tissue factor.