The Effectiveness Of Clopidogrel For Migraine Prophylaxis In Migraineurs With Right-to-lift Shunts

Objective: To explore the effect of clopidogrel on migraine patients with right to left shunt.Methods: To screen the patients with migraine and right to left shunts(RLS)according to the diagnostic criteria of migraine and the examination of contrast-enhanced transcranial Doppler(c-TCD),and record the partial flow.The subjects were divided into clopidogrel group and control group according to their willingness to receive clopidogrel.The clopidogrel group was treated with clopidogrel75 mg once a day for 3 months(30 days per month);the control group was still treated with the current acute phase of migraine and the prevention and treatment plan remained unchanged.The clopidogrel group was further divided into large and small shunt groups,aura and non aura groups,latent and inherent groups,and paroxysmal and chronic migraine groups.Migraine related score was used to evaluate the improvement of headache after 3 months of treatment in the two groups and the improvement of headache in each subgroup of clopidogrel group.Results: To investigate the clinical effect of clopidogrel in the treatment of chronic hepatitis B.methods: 126 patients were enrolled in this study,including 53 patients in clopidogrel group and 73 patients in control group.The MHI,HIT-6 and Midas scores(32.74 ± 44.97,53.96 ± 21.02 and 16.90 ± 12.06)of clopidogrel group were significantly lower than those of baseline(90.95 ± 46.88,61.80 ± 6.44 and 19.86 ±8.07),respectively(P = 0.000,P = 0.041 and P = 0.033).After 3 months,the MHI,HIT-6 and Midas scores of the control group(89.30 ± 37.57,59.62 ± 7.10 and 19.34 ±9.74)were lower than those of the baseline(101.43 ± 41.64,60.07 ± 7.79 and 20.18 ±10.09),but they were not statistically significant(P = 0.077,P = 0.722 and P =0.623).The mean improvement of migraine index(MHI)in clopidogrel group was63.32%,while that in control group was 10.08%.In the clopidogrel group,MHI,HIT-6 and Midas(12.57 ± 13.99,42.63 ± 26.10 and 9.75 ± 9.38)in the large shunt group were more significantly relieved than those in the small shunt group(41.97 ±51.07,59.14 ± 16.16 and 20.17 ± 11.83)(P = 0.029,P = 0.008 and P = 0.003);MHI,HIT-6 and Midas(15.94 ± 21.10,41.16 ± 25.87 and 10.47 ± 11.04)in the aura group were significantly relieved than those in the non aura group(42.72 ± 52.22,61.56 ±12.04)72 ± 11.12)(P = 0.038,P = 0.000 and P = 0.002).Conclusion: Clopidogrel can improve the headache of migraine patients with RLS,especially in patients with massive shunt and aural migraine,but there is no significant difference between latent and intrinsic RLS,chronic and paroxysmal migraine.