Cryptogenic Stroke and Migraine Headache: The Clinical Cardiologist's View

A B S T R A C T Cryptogenic stroke and migraine headache are disorders which most commonly af- fect persons younger than 55 years of age. In recent years these disorders have been found to have a strong association with inter-atrial cardiac defects, such as patent fo- ramen ovale and atrial septal defect, and support the pathophysiological mechanism of paradoxical embolism with a right-to-left shunt. With the evolution of technol- ogy, magnetic resonance imaging has more clearly defined cryptogenic stroke, and percutaneous cardiac interventional devices have offered a simplified approach to closure of inter-atrial cardiac defects. Nevertheless, the evidence-based data of which sub-populations of patients with cryptogenic stroke or migraine headache will benefit from closure of inter-atrial cardiac defects is just being defined. This review offers a clinical cardiologist's viewpoint of these developments.