1 / 20

Is ultrasound foam sclerotherapy contraindicated in patients with migraine ?

Is ultrasound foam sclerotherapy contraindicated in patients with migraine ?. By Claudine HAMEL-DESNOS, Caen, France. Should we treat varicose veins using UGFS* in patients with migraine?. Meier B et al. Eur Heart J 2012;33:705-713. Foam. Patent foramen ovale. MIGRAINE. *Abbreviations:

luke
Download Presentation

Is ultrasound foam sclerotherapy contraindicated in patients with migraine ?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Is ultrasound foam sclerotherapycontraindicated in patients with migraine? By Claudine HAMEL-DESNOS, Caen, France

  2. Should we treat varicose veins using UGFS* in patients with migraine? Meier B et al. Eur Heart J 2012;33:705-713 Foam Patentforamen ovale MIGRAINE *Abbreviations: PFO, patent foramen ovale; UGFS, ultrasound-guided foam sclerotherapy Neurological disturbances?

  3. « The results of NOMAS can be seen as the strongest evidence against an association between migraine or migraine with aura and PFO » Kurth K, Tzourio C, and Bousser MG. Editorial

  4. How does foam progress? • In vitro,2 ml of 3% sodium tetradecyl sulphate are deactivated by only 1 ml of blood in a short period of time (15 s) • The sclerosing agent does not reach the brain circulation • Only “bubbles” remain Watkins M.R. Deactivation of sodium tetradecyl sulphate injection by blood proteins. Eur J Vasc Endovasc Surg. 2011;41:521-525.

  5. Neurological disturbances • Visual (1.4%) • Migraine (4.2%) • Transient ischemic attacks • Stroke Mostly case reports Good recovery Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Systematic review of foam sclerotherapy for varicose veins. Br J Surg. 2007;94(8):925-936.

  6. What’s a migraine?

  7. The International Headache Societymigraine without aura: diagnostic criteria • At least 5 attacks fulfilling criteria B-D • Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated) • At least two of the following characteristics: • Unilateral location • Pulsating quality • Moderate or severe pain intensity • Aggravation by or causing avoidance of routine physical activity (eg walking or climbing stairs) • At least one of the following symptoms: • Nausea and/or vomiting • Photophobia and phonophobia • Not attributed to another disorder The International Classification of Headache Disorders. Cephalalgia. 2004;24:S9-S160.

  8. The International Headache Societymigraine with aura : diagnostic criteria • At least 2 attacks fulfilling criteria B-D • Aura consisting of at least 1 of the following, but no motor weakness: • fully reversible visual symptoms including positive features (eg, flickering lights, spots, or lines) and/or negative features (i.e, loss of vision); • fully reversible sensory symptoms including positive features (i.e, pins and needles) and/or negative features (i.e, numbness); • fully reversible dysphasic speech disturbance • At least 2 of the following : • homonymous visual symptoms and/or unilateral sensory symptoms • at least 1 aura symptom develops gradually over ≥5 min and/or diferent aura symptoms occur in succession over ≥5 min • each symptom lasts >5 and <60 minutes • Headache fulfilling criteria B-D for migraine without aura begins during the aura or follows the aura within 60 minutes • Not attributed to another disorder The International Classification of Headache Disorders. Cephalalgia. 2004;24:S9-S160.

  9. Pathophysiology of migraine associated with Ultrasound-Guided Foam Sclerotherapy (UGFS)

  10. Pathophysiology of migraine with aura (AM) Extensive cortical depression (propagated): Depolarization wave from the occipital cortex to the forehead (may be limited): • occipital = visual troubles • parietal = paresthesias • frontal = speech troubles Endothelin-1 (powerful vasoconstrictor) = triggers AM

  11. Endothelin and foam Visual disturbances= AM Varicose vein endothelium is damaged by foam and releases endothelin-1, which reaches the cerebral cortex via the PFO, triggering an aura. Visual disturbances are not transient ischemic attacks Foam →release of endothelin-1 Gillet et al. Phlebology. 2010;25:261-266. Frullini et al. Phlebology. 2011;26:203-208.

  12. According to expert recommendations: MIGRAINE WITH OR WITHOUT AURA IS NOT A CONTRAINDICATION FOR UGFS

  13. Breu FX, Guggenbichler S, Wollmann JC. 2nd European consensus meeting on foam sclerotherapy 2006. Tegernsee, Germany: Vasa 2008;S/713-729. Berridge D, Lees T, Earnshaw JJ. The VEnous Intervention (VEIN) project. Phlebology. 2009;24 (suppl 1):1-2.

  14. LITERATURE REVIEW

  15. 1023 articles analyzed • 41 articles retained reporting the presence of stroke, transient ischemic attacks (TIA) or visual or speech disturbances, migraine, cephalalgia (63% foam and 37% liquid) • 12 cases of stroke • 9 TIAs • 29 cases of migraine (0.27%) No personal history of migraine described Sarvananthan T, Sheperd AC, Willenberg T, Davis AH. Neurological complications of sclerotherapy for varicose veins. J Vasc Surg . 2012;55:243-251.

  16. There are insufficient data to determine the role of: • The technique used to generate foam, • The gas used, • The volumes injected, • The type of veins treated, • The different types of measures taken to avoid complications

  17. « The pathologic mechanisms resulting in CVA are likely to be different to those leading to migraine and visual disturbances »  • « Precautions should be exercised particularly in patients with a known PFO and perhaps those known to suffer from migraine » Sarvananthan T, Sheperd AC, Willenberg T, Davis AH. Neurological complications of sclerotherapy for varicose veins. J Vasc Surg 2012; 55:243-251.

  18. PRACTICAL RECOMMENDATIONS A symptomatic PFO is a contraindication for UGFS A personal history of migraine is not a contraindication for UGFS. However, it must be reported along with the presence or absence of aura Should migraine with/without aura occur after UGFS: • Treat the patient with his/her usual antimigraine treatment (or with NSAI) • In case of VDs, do not let the patient drive unaccompanied until the cessation of disturbances • The risk/benefit ratio should be reviewed before continuing sclerotherapy treatment (preventative antimigraine treatment?) • In case of stroke: assessment (Doppler examination of the supra-aortic vessels, consultation with a neurologist, consultation with a cardiologist, MRI); pharmacovigilance report.

  19. CONCLUSION • Neurological disturbances after UGFS should not be overlooked; however, they are usually AM variants • Strokes are rare side-effects and are not the result of the same underlying mechanisms; no link with a personal history of migraine has been established; stroke diagnosis must be confirmed • Currently, a history of migraine is not a contraindication for UGFS though it may contribute to the development of AM (or AM variant) • Further studies are needed

More Related