Symptoms similar to migraine with aura are rare following sclerotherapy treatment among patients with varicose veins of the lower extremities, according to a systematic review published in the journal Headache.
Researchers from the University of Copenhagen in Denmark searched publication databases through September 2021 for studies about neurologic complications following sclerotherapy treatment for lower limb varicose veins. A total of 28 articles were discussed.
Sclerotherapy is a minimally invasive treatment for varicose veins with well-established safety and efficacy. Despite its favorable safety profile, some transient and lasting neurologic outcomes have been reported. A previous review of post-sclerotherapy neurologic complications reported a total of 97 of these complications among 10,819 patients.
In this review, a total of 99 transient neurologic events occurred among 9343 patients who collectively underwent 22,327 sclerotherapy sessions, 6 neurological events among 1058 patients who underwent an unknown number of sclerotherapy sessions, and 20 neurological events following 12,173 sclerotherapy sessions among an unknown number of patients.
Overall, the researchers calculated a transient neurologic symptom event rate of 0.34% and probable migraine with aura rate of 0.02%. Stratified by sclerotherapy protocol, the event rates for transient neurologic symptoms and migraine with aura were 0.09% and 0.02% for liquid sclerotherapy and 0.51% and 0.02% for foam sclerotherapy, respectively.
It remains unclear what the biological mechanism of migraine after sclerotherapy could be. However, the researchers proposed some possibilities: the release of endothelian-1 and microembolization with a right-to-left shunt.
Of note, patients were rarely seen by a neurologist and the definition of migraine with aura varied across publications. Due to the rarity of events, the researchers could not eliminate the possibility that migraine with aura-like symptoms occurred by chance and not as a treatment side effect.
The researchers concluded that “Symptoms resembling migraine aura may be triggered during or after sclerotherapy, possibly due to microembolization through a right-to-left shunt. A better term for this phenomenon would be secondary cortical spreading depolarization rather than migraine aura-like symptoms. It is likely a rare phenomenon with few published cases compared to the millions of sclerotherapy injections conducted to date.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Bahtiri L, Thomsen AV, Ashina M, Hougaard A. Migraine aura-like episodes following sclerotherapy for varicose veins of the lower extremities—a systematic review. Headache. Published online January 12, 2023. doi:10.1111/head.14448