Abstract
Objective
This systematic review provides a summary and evaluation of cases of migraine aura‐like episodes elicited by sclerotherapy of veins of the lower extremities and discusses possible underlying mechanisms.
Background
Sclerotherapy is a commonly used treatment for varicose veins. Symptoms resembling migraine aura have been reported during and following sclerotherapy of the lower extremities, suggesting that sclerotherapy may elicit migraine aura.
Methods
We searched PubMed for articles reporting neurological complications that were transient and fully reversible following sclerotherapy treatment for varicose veins in the lower limbs. There were no restrictions regarding article language or publication date. Only original studies and case reports were included. Two authors independently reviewed included articles in detail. Data were extracted from each article, including details on symptoms, previous migraine history, sclerotherapy method, and the presence of a right‐to‐left cardiac shunt in patients. We evaluated whether episodes fulfilled modified International Classification of Headache Disorders, 3rd edition, criteria for 1.2 Migraine with aura or 1.5.2 Probable migraine with aura.
Results
The search yielded 777 articles, 28 of which were included. Twenty‐six articles reported 119 episodes of transient neurological symptoms in 34,500 sclerotherapy sessions. Two additional articles reported six episodes of transient neurological symptoms with no specification of the number of sessions. Of the 125 episodes, 119 involved transient visual disturbances, and eight met the modified criteria for Probable migraine with aura. In most episodes (98%), clinical information was insufficient to determine if the criteria were fulfilled.
Conclusions
Symptoms that are clinically indistinguishable from migraine with aura attacks may occur following sclerotherapy, although this likely is rare. Microembolization through a right‐to‐left shunt triggering cortical spreading depolarization is a possible mechanism. Our findings are limited by infrequent specific assessments for neurological complications and a low level of detail in the description of symptoms in the available literature. Future prospective studies are needed to determine this phenomenon's incidence and underlying mechanisms.
Keywords: aura, complication, depolarization, migrainous, spreading depression, visual disturbances
Abbreviations
- CSD
cortical spreading depolarization
- ET‐1
endothelin‐1
- FS
foam sclerotherapy
- ICHD
International Classification of Headache Disorders
- LS
liquid sclerotherapy
- PFO
patent foramen ovale
- RLS
right‐to‐left shunt
- TIA
transient ischemic attack
INTRODUCTION
Sclerotherapy is a commonly used, minimally invasive treatment for varicose veins in the lower extremities with well‐established efficacy and safety. 1 The procedure entails injecting a solution directly into a vein. The blood clots as a result of the solution's irritation of the blood vessel's lining, which leads to its collapse and adhesion. The blood vessel eventually transforms into scar tissue that vanishes from sight. 1 Despite a good safety profile, transient and lasting neurological symptoms following the procedure have been reported. Because of the similarities in clinical features and a history of migraine in some treated individuals, transient neurological symptoms following sclerotherapy have been classified as migraine aura in some cases.
A previous systematic review of neurological complications following sclerotherapy for varicose veins found 97 occurrences of neurological symptoms in 10,819 patients undergoing the procedure. 2 The authors categorized these as either “cerebrovascular accidents,” transient ischemic attacks (TIA), or “migraine.” Neuroimaging confirmed ischemic strokes in some cases, but few clinical details were provided for symptoms of suspected TIA and migraine. The diagnostic criteria for migraine, as defined by the International Classification of Headache Disorders (ICHD), 3 were not applied to verify the migraine diagnosis. A review of visual disturbances following sclerotherapy found that the incidence of such disturbances ranges from 0% to 4% in randomized clinical trials. 4 The review recorded no clinical details of the visual disturbances, except for categorizing them as either “unilateral” or “bilateral.” Nevertheless, the review mentioned that their “mechanism appears to be that of migraine with aura.” Neurologists have not previously reviewed the clinical features of suspected migraine aura‐like symptoms following sclerotherapy.
Around one‐third of patients with migraine experience migraine aura that usually precedes the migraine headache and is commonly present as visual or sensory disturbances. 5 Migraine is a primary headache disorder, meaning that it, by definition, cannot be caused by underlying disorders. However, various factors, including cerebral cortical lesions and vascular pathology associated with cerebral embolisms, such as carotid dissection or stenosis, may trigger attacks of symptoms that are indistinguishable from migraine aura with or without a subsequent headache. 6 , 7 Other intravascular procedures have been shown to induce migraine aura‐like symptoms in humans, including cerebral angiography by carotid puncture, vertebral angiography, and transseptal cardiac catheterization. 8 In animal models, cortical spreading depolarization (CSD), the likely underlying pathophysiological phenomenon of the migraine aura, may be elicited via cortical damage, cortical application of depolarizing substances, electrical stimulation, optogenetics, and microembolization. 9 Possibly, similar cortical damage or irritation could trigger migraine aura‐like symptoms in patients. Indeed, a recent case report demonstrated an episode of CSD, recorded using subdural electrodes, during an episode of gradually spreading migraine aura‐like symptoms in a patient following an aneurysmal subarachnoid hemorrhage. 10
In the case of sclerotherapy, a potential mechanism for developing CSD could be focal cerebral ischemia due to microembolization. This mechanism would depend on the presence of a right‐to‐left cardiac or pulmonary shunt. Microbubbles in the middle cerebral artery and bubbles in the left heart following sclerotherapy, 1 min after sclerosant injection, have been observed by ultrasound. 11 Additionally, a case report demonstrated that a middle cerebral artery occlusion stroke in a patient treated with sclerotherapy was due to a clot consisting of the polidocanol foam used for the procedure. 12
These observations, coupled with the transient neurological symptoms described following sclerotherapy, raise the question of whether sclerotherapy could elicit migraine aura‐like symptoms in patients. Investigations into this relation could help increase the understanding of migraine with aura (MWA) mechanisms and could potentially be important in assessing the safety of sclerotherapy. In this systematic review, we aimed to summarize the available published literature on patients with varicose veins of the lower extremities (Population) undergoing sclerotherapy for this condition (Intervention) and reporting migraine aura‐like symptoms (Outcome). No control population or control intervention was considered. Further, we aimed to discuss the possible underlying mechanisms of these symptoms.
METHODS
This review was conducted and reported in agreement with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis Guidelines (PRISMA). 13
Search strategy and study selection
We searched PubMed for all studies reporting migraine aura‐like symptoms after sclerotherapy for varicose veins. The search paired sclerotherapy terms with a set of descriptive terms, including a neurological element, to identify articles that did not necessarily mention the complications as migraine aura‐like symptoms. The following search string was used: (sclerotherapy OR “varicose vein”) AND (“migraine with aura” OR migraine OR aura OR neurological OR visual OR sensory OR speech OR language). There were no limitations regarding language or publication date. Two authors (L.B. and A.V.T.) independently screened the titles and abstracts of the articles. Articles reporting transient and fully reversible neurological symptoms were reviewed in detail. We also reviewed reference lists of relevant articles to identify any studies that might have been missed in the search.
Eligibility
We included all articles reporting neurological complications identified as migraine aura or characterized by being transient and fully reversible following sclerotherapy treatment for varicose veins in the lower limbs. Article types could include, for example, case reports, case series, and randomized clinical trials, and no restrictions on study design were applied. Animal and laboratory studies were excluded. To avoid data duplication, only original articles were included. No other specific exclusion criteria were applied.
Data extraction
Two authors (L.B. and A.V.T.) independently reviewed included articles in detail. Discrepancies were solved through consensus. The following data were extracted: author, year of publication, number of patients treated, number of sclerotherapy sessions, number of episodes of transient neurological symptoms reported, age, sex, types of symptoms, whether or not the aura‐like symptoms underwent a gradual spreading over more than 5 min, if two or more aura‐like symptoms occurred in succession, if symptoms lasted 5–60 min, if symptoms were unilateral, if symptoms were positive (e.g., scintillation or flickering in the case of visual symptoms), whether or not symptoms were accompanied by a headache, if the patient had a previous history of migraine with or without aura, the timing of symptoms related to sclerotherapy, which vein and leg was treated, the type and concentration of sclerosant used, applied volume, whether or not foam was used, whether the presence of a right‐to‐left shunt (RLS) was evaluated, and whether an RLS was identified.
Furthermore, we evaluated migraine aura‐like cases episodes according to the criteria of the ICHD, 3rd edition (ICHD‐3), 3 for the categories 1.2 Migraine with aura and 1.5.2 Probable migraine with aura, excluding the criterion “Not better accounted for by any other ICHD diagnosis.” Episodes were only recognized as fulfilling the modified ICHD criteria if there was enough information to corroborate the diagnosis, regardless of the authors' claim that ICHD criteria were met.
Statistics
We calculated the frequency of migraine aura‐like episodes, defined as episodes fulfilling the modified criteria for ICHD‐3 categories 1.2 or 1.5.2 (see above), based on the total number of sclerotherapy sessions in which patients were screened for neurological complications. We further calculated the frequency of missing data for each category (see above) in the included cases. No statistical software was used for the calculations.
Review protocol
No review protocol was developed for the study.
RESULTS
The search on PubMed was performed on September 3, 2021. The search yielded 777 articles. After screening the titles and abstracts for eligibility, we retrieved 38 articles, of which 28 were subsequently included. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 The screening process is summarized in Figure 1. An overview of the included articles is provided in Table 1.
FIGURE 1.

PRISMA 2009 flow diagram of this systematic review. Among 777 records identified through the search, 777 were screened. After excluding 739 records, 38 full‐text articles were assessed for eligibility. Of these, 28 studies were included in the systematic review. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses
TABLE 1.
Overview of included studies
| Study | Study type | Number of patients | Number of sclerotherapy sessions | Screening for neurological symptoms | Instances of transient neurological symptoms | Neuroimaging‐verified strokes | Episodes fulfilling criteria for probable MWA | Comments |
|---|---|---|---|---|---|---|---|---|
| Miranda et al. (2021) 18 | Retrospective study | 55 | 91 | No | 1 | 0 | 0 | |
| Abdelhamid et al. (2018) 41 | Case report | 1 | 1 | No | 1 | 1 | 0 | |
| Malvehy et al. (2016) 40 | Case report | 1 | 1 | No | 1 | 0 | 0 | |
| Kim et al. (2016) 39 | Case report | 1 | 1 | No | 1 | 0 | 0 | |
| Rastel et al. (2016) 20 | Case report | 1 | 5 | No | 1 | 0 | 1 | |
| Krnić et al. (2015) 38 | Prospective study | 81 | NS | No | 1 | 0 | 0 | |
| Coudray et al. (2015) 31 | Case report | 1 | 1 | No | 1 | 0 | 1 | |
| Zouitina et al. (2014) 19 | Case report | 1 | 3 | No | 1 | 0 | 1 | |
| Hill et al. (2014) 27 | Retrospective study | 1831 | 8248 | No | 9 | 0 | 3 | Patients with a history of MWA were either treated with liquid sclerosant or screened for right‐to‐left shunts and excluded if positive |
| Leong et al. (2011) 37 | Case report | 1 | 1 | No | 1 | 0 | 0 | |
| Bhogal et al. (2011) 34 | Prospective study | 112 | 163 | No | 1 | 0 | 0 | |
| Beckitt et al. (2011) 33 | Prospective study | 470 | 470 | No | 1 | 0 | 0 | |
| Gillet et al. (2010) 28 | Prospective study | 20 | 20 | Yes, including description of any visual disturbances, headache, paresthesia and dysphasic speech | 20 | 0 | 0 | |
| Bradbury et al. (2010) 32 | Prospective study | 977 | NS | Yes. “Patients were asked about visual disturbances and any other neurological symptoms” | 5 | 0 | 0 | |
| Guex et al. (2010) 15 | Prospective study | 1605 | 6444 | Yes, visual disturbances, headache, nausea and vomiting | 13 | 0 | 0 | |
| Morrison et al. (2010) 22 | Prospective study | 100 | 100 | Yes, including dizziness, circumoral paresthesia, visual disturbance, nausea, and headache | 2 | 0 | 0 | Patients who reported MWA were screened for PFO. Patients with a PFO were excluded |
| Nael et al. (2010) 23 | Retrospective study | 166 | 166 | No | 2 | 0 | 0 | |
| Hartmann et al. (2009) 29 | Case report | 1 | 1 | No | 1 | 0 | 1 | |
| Gillet et al. (2009) 30 | Prospective study | 1025 | 1025 | Yes, including visual disturbances | 19 | 1 | 0 | Patient with a PFO and/or MWA were excluded |
| Raymond‐Martimbeau et al. (2009) 21 | Prospective study | 3259 | 4891 | No | 3 | 0 | 0 | |
| Bush et al. (2008) 36 | Case series | 2 | 2 | No | 1 | 2 | 0 | |
| Morrison et al. (2008) 24 | Prospective study | 177 | 177 | No | 8 | 0 | 0 | |
| Yilmaz et al. (2007) 35 | Prospective study | 29 | 29 | No | 1 | 0 | 0 | |
| Künzlberger et al. (2006) 25 | Case report | 1 | 4 | No | 1 | 0 | 0 | |
| Bergan et al. (2006) 16 | Prospective study | 332 | 332 | No | 5 | 0 | 0 | |
| Guex et al. (2006) 15 | Prospective study | NS | 12,173 | Yes, including headache, paresthesia, visual disturbances, nausea and vomiting | 20 | 0 | 0 | |
| Kern et al. (2004) 14 | Randomized clinical trial | 150 | 150 | No | 3 | 0 | 0 | |
| Van der Plas et al. (1994) 17 | Case report | 1 | 1 | No | 1 | 0 | 0 |
Abbreviations: MWA, migraine with aura; NS, not specified; PFO, patent foramen ovale.
In summary, 25 articles reported 99 episodes of transient neurological symptoms out of 22,327 sclerotherapy sessions performed in 9343 individual patients. Two articles reported six episodes of transient neurological symptoms in 1058 individual patients without reporting the exact number of sessions. The remaining article reported 20 episodes of transient neurological symptoms in 12,173 sessions without reporting the exact number of individual patients. In total, 125 episodes of transient neurological symptoms were reported in 125 individual patients. Details about the 125 episodes, including patient demographics, sclerotherapy technique, and symptom characteristics, are provided in Table S1. Eight of these episodes fulfilled the modified ICHD‐3 criteria for Probable migraine with aura. No episodes met the modified criteria for Migraine with aura, despite the symptoms fulfilling the clinical characteristics, because each patient reported only one episode. Details of these eight patients and their migraine aura‐like symptoms are provided in Table 2. In all but one of the remaining 117 episodes, insufficient clinical details about the transient neurological symptoms were provided to determine if the ICHD‐3 criteria were fulfilled. Frequencies of missing data for each data category are provided in Table S1. For example, it was not reported whether or not symptoms were gradually spreading in 98% of cases, and the duration of symptoms was not reported in 82% of cases.
TABLE 2.
Characterization of patients fulfilling modified criteria for probable migraine
| Case | Year | Age/Sex | Author's description | Symptoms | Characteristics | History of migraine | Type of sclerotherapy | RLS present | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Visual | Sensory | Speech | Gradually spreading | Two or more aura in succession | Duration 5–60 min | Unilateral symptom | Positive symptom | Accompanied, or followed within 60 min, by headache | |||||||
| 5 | 2014 | 44/F 27 | MWA | No | Yes | No | NS | No | Yes | Yes | Yes | No | No | FS | Yes |
| 6 | 2014 | 22/F 27 | MWA | Yes | Yes | Yes | NS | Yes | Yes | Yes | Yes | Yes | MWoA | LS | NS |
| 7 | 2009 | 37/M 29 | Visual and speech disturbance | Yes | No | Yes | NS | No | Yes | Yes | Yes | No | NS | FS | Yes |
| 8 | 2006 | 23/F 25 | Visual and sensory disturbance | Yes | Yes | No | Yes | Yes | No | Yes | Yes | Yes | NS | LS | No PFO |
Abbreviations: FS, foam sclerotherapy; L, left; LS, liquid sclerotherapy; MWA, migraine with aura; MWoA, migraine without aura; N/A, not applicable; NS, not specified; PFO, patent foramen ovale; R, right; RLS, right‐to‐left shunt.
Of the total 34,500 sclerotherapy sessions (excluding the two articles not specifying the number of sessions), 119 episodes of transient neurological symptoms were reported (0.34%), and seven of these fulfilled modified criteria for Probable migraine with aura (0.02%). Considering only prospective studies reporting the exact number of sessions and specifically screening for neurological symptoms, four studies comprising 19,742 sclerotherapy sessions reported 54 episodes of transient neurological symptoms (0.27%). None of these episodes fulfilled the modified criteria for Probable migraine with aura. An overview of the frequencies of transient neurological symptoms and migraine aura‐like symptoms in studies with and without screening for neurological complications is provided in Figure 2.
FIGURE 2.

Flow diagram showing the frequency of transient neurological symptoms and episodes fulfilling the criteria for “Probable migraine with aura” in articles with and without screening for neurological symptoms. aData from the 26 of the 28 included articles that reported the exact number of sclerotherapy sessions. The 34,500 sessions were carried out in 9343 individual patients. bOf these, 21 sessions were presented in case reports of a total of 12 individual patients, reporting a total of 11 episodes of transient neurological symptoms. NS, not specified
The age of treated patients ranged from 17 to 90 years. Polidocanol and sodium‐tetradecyl sulfate were used for sclerotherapy. The sclerosants were used in the form of both liquid and foam. Of 12,487 sessions with liquid sclerotherapy (LS), 11 episodes of transient neurological symptoms (0.09%), and three fulfilling modified criteria for Probable migraine with aura (0.02%), were reported. Of 22,008 sessions with foam sclerotherapy (FS), 113 episodes of transient neurological symptoms (0.51%), and four fulfilling modified criteria for Probable migraine with aura (0.02%), were reported.
The presence of an RLS was evaluated in 18 of 125 patients, using either transthoracic echocardiography (n = 3), bubble echocardiography (n = 4), transesophageal echocardiography (n = 5), or contrast transcranial Doppler (n = 3). In 13 of 18 patients, a patent foramen ovale (PFO) was identified, and a non‐specified RLS was identified in three patients. A PFO had been ruled out in one patient, but the authors did not elaborate on the method or whether RLSs other than PFO had been investigated. 25 In the last patient, a PFO could not be excluded. 37 This patient, as well as five additional patients with RLS, met the modified criteria for Probable migraine with aura. In some of the included studies, patients with a PFO were excluded. 22 , 27 , 30 Furthermore, one patient experienced an episode of vasovagal syncope, while three others experienced near‐syncope symptoms such as faintness, nausea, and lightheadedness.
Patients were rarely evaluated by a neurologist. In one article, 28 a neurologist concluded that some patients' symptoms met the clinical criteria of MWA. This article did not present data for each patient, and we could not confirm if the criteria were fulfilled. A total of 30 episodes were classified by authors as migraine aura or migraine aura‐like symptoms. Authors' definitions of aura varied, with, for example, one article 27 defining aura as a visual disturbance and/or paresthesia or aphasia associated with a migrainous headache rather than according to accepted diagnostic criteria.
DISCUSSION
In this systematic review, we demonstrated that sclerotherapy for varicose veins in the lower extremities might, in rare cases, elicit symptoms indistinguishable from migraine aura. We identified eight episodes with clinical characteristics fulfilling current criteria for MWA except for the requirements of at least two attacks and no other diagnosis better accounting for the symptoms. Due to a lack of information, the majority of the remaining 117 patients had symptoms for which a diagnosis could not be established. Potentially, more episodes would have fulfilled the criteria if complete information had been provided.
Occurrence of migraine aura following sclerotherapy
The true incidence of aura‐like symptoms after sclerotherapy is unclear, and the present study is limited by the design of the included studies. The vast majority of studies did not screen for aura‐like symptoms specifically. Most episodes resembling migraine aura were reported in case reports, as is the case for occurrences of TIA and stroke following sclerotherapy. It is important to note that several studies excluded patients with a history of MWA and a presence of a PFO.
Even though none of the reviewed studies were designed to evaluate the incidence of migraine aura‐like symptoms following sclerotherapy, it is safe to conclude that neurological complications, including symptoms resembling migraine aura, rarely occur following this procedure. In large prospective studies screening specifically for neurological complications, including visual disturbances, the incidence of any transient neurological symptom was less than 1%.
Based on the low frequency of these events, it could be argued that migraine aura‐like symptoms may have occurred by chance rather than as a consequence of sclerotherapy. However, based on the consistent reporting of aura‐like symptoms, a plausible pathophysiological mechanism (see below), the relatively low frequency of spontaneous MWA attacks, and the observation that most patients did not have a previous history of MWA, we believe that there is a causal relation.
In most of the individual episodes of neurological symptoms, we could not establish a diagnosis of migraine aura due to insufficient information. Notably, both TIAs and ischemic strokes have been well documented after sclerotherapy, 39 , 42 , 43 , 44 , 45 and episodes may have been clinically typical of TIA rather than migraine aura. Indeed, TIA and migraine aura are frequently mistaken for one another in clinical practice. 46 It is often challenging to distinguish migraine aura from TIAs without the presence of positive symptoms and a gradual spread. However, positive symptoms and a gradual spread were present in episodes that met the modified criteria, whilst several other episodes presented with negative symptoms, which may have represented TIAs rather than aura symptoms. The observation that most episodes involved transient visual disturbances, which are much more common in migraine aura than TIA, suggests that the true incidence of migraine aura‐like symptoms may have been underestimated.
Other potential differential diagnoses in transient visual symptoms are syncope or near‐syncope, which may be associated with visual symptoms such as blurring, scotomas, and a headache. Interestingly, faintness was described in some patients, and in one patient, a vasovagal syncope was identified. Consequently, symptoms may, in some cases, have been caused by a near‐syncope rather than an aura.
Potential underlying mechanisms
How sclerotherapy may trigger aura symptoms remains speculative, but one possible explanation that has received particular attention is microembolization through a PFO. 28 Microembolization has successfully evoked recurrent CSDs in the mouse brain. 47 In humans, migraine has been demonstrated following contrast injection through a femoral artery catheter during vertebral angiography and after a carotid puncture, for the latter of which microembolization has been implicated as a possible cause in a mouse model. 48 , 49
In the case of sclerotherapy, bubbles in the left heart have been demonstrated 1 min after injection, and microbubbles in the middle cerebral artery have been demonstrated using transcranial Doppler. 11 Additionally, a case report has revealed pathological evidence of paradoxical embolism with polidocanol foam in a patient treated with sclerotherapy. 12
The presence of an RLS in five of our eight patients with episodes fulfilling the criteria (an RLS was not clearly ruled out in the remaining three) supports the hypothesis that the aura‐like symptoms are due to microembolization via paradoxical embolism. Likewise, a PFO was confirmed in 11 of 16 cases of TIA or cerebrovascular accidents after sclerotherapy in patients who underwent cardiac investigations afterward. 2 Ischemic strokes in the posterior circulation are more likely to be caused by cardioembolism than ischemic strokes in other vascular territories. 50 This is congruent with our findings of aura‐like symptoms primarily arising from the occipital lobes.
Episodes of aura‐like symptoms following LS challenge the hypothesis of microembolization as a trigger for aura. Previous reports of gaseous emboli and foam‐derived bubble emboli indicate that the sclerosant agent causes an embolus on its own. 11 However, it appears less probable that the liquid sclerosants would create an embolus. Even though aura‐like symptoms occurred with LS, they tend to be more frequent with FS in our small sample. Given that several of the included articles aimed at examining the use of FS, this was also the most common type among the total sessions included. We cannot determine whether aura‐like symptoms are more common with FS or if there are fewer reported episodes with LS.
Another proposed trigger of aura‐like symptoms in sclerotherapy is the release of endothelin‐1 (ET‐1), a vasoconstrictor peptide, from vascular endothelium. 51 Cortical application of ET‐1 has been shown to trigger CSD in animal models. 52 However, a human study in patients with MWA failed to induce aura after infusion of ET‐1. 53 Notably, plasma concentrations of ET‐1 in this study were up to 30 times higher than that measured in patients after sclerotherapy. 51 We find the ET‐1 hypothesis to be an unlikely explanation for the aura‐like symptoms observed and consider it more plausible that the underlying trigger of aura symptoms after sclerotherapy is microembolization through an RLS.
CONCLUSION AND FUTURE PERSPECTIVES
Symptoms resembling migraine aura may be triggered during or after sclerotherapy, possibly due to microembolization through an RLS. 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. Detailed prospective recording of migraine aura‐like symptoms following sclerotherapy combined with an evaluation of the presence of RLS should be carried out. Such investigations may help increase our understanding of migraine aura and more accurately assess the safety of sclerotherapy.
AUTHOR CONTRIBUTIONS
Study concept and design: Lionesa Bahtiri, Andreas Vinther Thomsen, Messoud Ashina, Anders Hougaard. Acquisition of data: Lionesa Bahtiri, Andreas Vinther Thomsen. Analysis and interpretation of data: Lionesa Bahtiri, Andreas Vinther Thomsen, Messoud Ashina, Anders Hougaard. Drafting of the manuscript: Lionesa Bahtiri, Andreas Vinther Thomsen. Revising it for intellectual content: Lionesa Bahtiri, Andreas Vinther Thomsen, Messoud Ashina, Anders Hougaard. Final approval of the completed manuscript: Lionesa Bahtiri, Andreas Vinther Thomsen, Messoud Ashina, Anders Hougaard.
FUNDING INFORMATION
M.A. was supported by the Lundbeck Foundation Professor Grant (R310‐2018–3711).
CONFLICT OF INTEREST
Lionesa Bahtiri and Andreas Vinther Thomsen declare no conflicts of interest. Anders Hougaard has received honoraria for lecturing and/or writing from Allergan, Novartis, Teva, Lundbeck, and Eli Lilly. He serves as Assistant Editor of Headache. Messoud Ashina is a principal investigator on clinical trials for AbbVie, Amgen, Eli Lilly, Lundbeck, and Novartis; has received personal fees from AbbVie, Amgen, Eli Lilly, Lundbeck, Novartis, Percept Corporation, and Teva; has received research grants from Lundbeck Foundation, Novo Nordisk Foundation, and Novartis; and serves as an Associate Editor of Cephalalgia, Associate Editor of The Journal of Headache and Pain, and Associate Editor of Brain. He has no ownership interest and does not own stocks of any pharmaceutical company.
Supporting information
Table S1
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. 2023;63:40‐50. doi: 10.1111/head.14448
DATA AVAILABILITY STATEMENT
Data are available from the authors upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Table S1
Data Availability Statement
Data are available from the authors upon reasonable request.
