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Systemic right-to-left shunts, ischemic brain lesions, and persistent migraine activity.
Neurology. 2016 05 03; 86(18):1668-75.Neur

Abstract

OBJECTIVE

To assess whether migraine in the general population is associated with increased risk of systemic right-to-left shunts (RLS) and whether RLS are associated with increased prevalence of brain infarcts and persistent recurrence of migraine attacks at older age.

METHODS

Brain MRI and transcranial Doppler with air contrast in 166 unselected migraineurs (mean age ± SD 56 ± 7.7 years; 70% women; n = 96 migraine with aura) and 69 controls (mean age ± SD 55 ± 7.6 years; 65% women) from the general population.

RESULTS

Participants with migraine with aura more frequently had Valsalva-induced RLS (60%), in particular large-sized, compared to controls (42%; odds ratio [OR] 2.1; 95% confidence interval [CI] 1.1-3.9; p = 0.02) and participants with migraine without aura (40%; OR 2.3; 95% CI 1.2-4.3; p = 0.01). They also more frequently had spontaneous RLS (35%) than participants with migraine without aura (17%; OR 2.6; 95% CI 1.3-5.6; p = 0.01) but not compared to controls (26%; OR 1.6; 95% CI 0.8-3.1; p = 0.2). Participants with migraine with aura and spontaneous RLS more frequently had persistent migraine activity (85%) than participants with migraine without spontaneous RLS (63%; OR 3.4; 95% CI 1.2-10.1; p = 0.03). Nine percent of participants with RLS had silent posterior circulation infarcts compared to 3% of participants without RLS (OR 2.8; 95% CI 0.9-9.3; p = 0.08), independent of migraine status. RLS were not associated with white matter lesions.

CONCLUSIONS

RLS are more prevalent in migraineurs with aura but do not explain the increased prevalence of silent posterior circulation infarcts or white matter lesions in migraineurs. Spontaneous RLS are associated with persistent migraine.

Authors+Show Affiliations

From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD. h.koppen@hagaziekenhuis.nl.From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26968513

Citation

Koppen, Hille, et al. "Systemic Right-to-left Shunts, Ischemic Brain Lesions, and Persistent Migraine Activity." Neurology, vol. 86, no. 18, 2016, pp. 1668-75.
Koppen H, Palm-Meinders IH, Mess WH, et al. Systemic right-to-left shunts, ischemic brain lesions, and persistent migraine activity. Neurology. 2016;86(18):1668-75.
Koppen, H., Palm-Meinders, I. H., Mess, W. H., Keunen, R. W., Terwindt, G. M., Launer, L. J., van Buchem, M. A., Kruit, M. C., & Ferrari, M. D. (2016). Systemic right-to-left shunts, ischemic brain lesions, and persistent migraine activity. Neurology, 86(18), 1668-75. https://doi.org/10.1212/WNL.0000000000002538
Koppen H, et al. Systemic Right-to-left Shunts, Ischemic Brain Lesions, and Persistent Migraine Activity. Neurology. 2016 05 3;86(18):1668-75. PubMed PMID: 26968513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systemic right-to-left shunts, ischemic brain lesions, and persistent migraine activity. AU - Koppen,Hille, AU - Palm-Meinders,Inge H, AU - Mess,Werner H, AU - Keunen,Ruud W, AU - Terwindt,Gisela M, AU - Launer,Lenore J, AU - van Buchem,Mark A, AU - Kruit,Mark C, AU - Ferrari,Michel D, Y1 - 2016/03/11/ PY - 2015/06/26/received PY - 2016/01/26/accepted PY - 2016/3/13/entrez PY - 2016/3/13/pubmed PY - 2017/4/30/medline SP - 1668 EP - 75 JF - Neurology JO - Neurology VL - 86 IS - 18 N2 - OBJECTIVE: To assess whether migraine in the general population is associated with increased risk of systemic right-to-left shunts (RLS) and whether RLS are associated with increased prevalence of brain infarcts and persistent recurrence of migraine attacks at older age. METHODS: Brain MRI and transcranial Doppler with air contrast in 166 unselected migraineurs (mean age ± SD 56 ± 7.7 years; 70% women; n = 96 migraine with aura) and 69 controls (mean age ± SD 55 ± 7.6 years; 65% women) from the general population. RESULTS: Participants with migraine with aura more frequently had Valsalva-induced RLS (60%), in particular large-sized, compared to controls (42%; odds ratio [OR] 2.1; 95% confidence interval [CI] 1.1-3.9; p = 0.02) and participants with migraine without aura (40%; OR 2.3; 95% CI 1.2-4.3; p = 0.01). They also more frequently had spontaneous RLS (35%) than participants with migraine without aura (17%; OR 2.6; 95% CI 1.3-5.6; p = 0.01) but not compared to controls (26%; OR 1.6; 95% CI 0.8-3.1; p = 0.2). Participants with migraine with aura and spontaneous RLS more frequently had persistent migraine activity (85%) than participants with migraine without spontaneous RLS (63%; OR 3.4; 95% CI 1.2-10.1; p = 0.03). Nine percent of participants with RLS had silent posterior circulation infarcts compared to 3% of participants without RLS (OR 2.8; 95% CI 0.9-9.3; p = 0.08), independent of migraine status. RLS were not associated with white matter lesions. CONCLUSIONS: RLS are more prevalent in migraineurs with aura but do not explain the increased prevalence of silent posterior circulation infarcts or white matter lesions in migraineurs. Spontaneous RLS are associated with persistent migraine. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/26968513/Systemic_right_to_left_shunts_ischemic_brain_lesions_and_persistent_migraine_activity_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=26968513 DB - PRIME DP - Unbound Medicine ER -