Long term migraine is actually a "careful eye" trick
2021-12-30
The young girl was troubled by migraine for a long time. After a series of examinations, it was found that the root of the disease was a small round hole in her heart. How did the heart "break a hole"? Should this situation be treated? Listen to the doctor. Case playback: the root cause of headache was originally in the heart Xiao Wang is a girl in her 20s. She is usually in good health. She has an old problem. She often has a headache on the right side. The headache is pulsatile, accompanied by nausea, fatigue and other symptoms. Xiao Wang thought it was because he was too tired and worked under too much pressure. He took a rest or oral painkillers every time he had a headache. Although the headache symptoms have been alleviated, they still occur repeatedly, which has seriously affected Xiao Wang's work and life. Xiao Wang has visited many hospitals and considered migraine, but there was no good treatment effect, so he came to the neurology clinic of our hospital. After a series of examinations in the Department of Neurology, EEG, brain CT, cervical vascular ultrasound and transthoracic cardiac ultrasound were normal. Finally, the doctor confirmed that the root cause of Xiao Wang's migraine was in the heart, because the heart had a "careful eye", and the disease was called "patent foramen ovale". Xiao Wang further performed transesophageal echocardiography and confirmed the existence of patent foramen ovale. This small hole in the heart used to be very useful What is patent foramen ovale? Foramen ovale is a small hole between the left and right atrium. When we are fetuses, blood will flow from the foramen ovale from the right atrium to the left atrium to maintain our normal blood circulation. When a newborn is born, with the first cry, the pressure of the right atrium increases, and the foramen ovale is functionally closed, reaching anatomical closure within one year. If the foramen ovale is not closed over the age of 3, it is called patent foramen ovale. Why does patent foramen ovale cause migraine? It turns out that when patent foramen ovale occurs, the venous blood in our right atrium flows directly through this hole to the arterial blood in the left atrium. Because the blood flow velocity of venous blood is slow, micro thrombus is easy to appear in venous blood, and these micro thrombus will flow directly into the artery from the foramen ovale. If micro thrombus flows into the cerebral artery, it will lead to migraine and even cerebral infarction. Patent foramen ovale is also an important cause of stroke in young people. Therefore, it is specially reminded that if young patients repeatedly have unexplained migraine or cerebral embolism, we must be vigilant about whether there is a "careful eye" patent foramen ovale in the heart. Asymptomatic, no history, foramen ovale "may not need treatment" What if you have patent foramen ovale? Don't worry, the prognosis of the disease is generally good. Statistics show that 1 / 4 of adults suffer from patent foramen ovale. Expert consensus in the United States points out that for patients without any symptoms and stroke history, it is not recommended to intervene in patent foramen ovale; For patients with stroke, migraine, recurrent vertigo and other diseases, professional doctors are required to clarify the etiology. If considering that the symptoms are related to patent foramen ovale, the patient should pay attention to avoid forced cough, defecation, forced breath closing, weight-bearing, sleep apnea and other actions that induce increased thoracic pressure in daily life. At the same time, doctors of Neurology, cardiovascular medicine and imaging department are required to evaluate the treatment method of patients according to their age, bleeding risk, anatomical structure of patent foramen ovale, stroke risk factors, imaging characteristics and clinical clues. The treatment of patent foramen ovale includes drug treatment and surgical treatment. Drug treatment is mainly anticoagulant or antiplatelet drugs, which can prevent stroke. Surgical treatment includes interventional closure and surgical treatment. Interventional closure is a minimally invasive operation. The catheter is sent to the right atrium through the femoral vein at the root of the thigh, passes through the patent foramen ovale to the left atrium, releases the special occluder, and then closes the foramen ovale to achieve the purpose of radical cure. The surgical technique is mature, the patient has little pain and rapid recovery. It has been widely used in clinic. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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