Prevalence and extent of right-to-left shunt on contrast-enhanced transcranial Doppler in Chinese patients with migraine in a multicentre case-control study

Wang, Si-Bo; Liu, Kangding; Yang, Yi; Li, Yajie; Hu, Ming‐yi; Lin, Pang; Guo, Rong; Tian, Qing; You, Yong; Cui, Yunkang; Zhang, Guanling; Dong, Zhao; Gao, Yongsheng; Xing, Yingqi

doi:10.1177/0333102417708203

Cited by 29 publications

(33 citation statements)

References 24 publications

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“…Our findings reveal that patients with RLS have higher proportions of NM, suggesting that large hemodynamic changes may significantly relate to migraine symptoms in CHD patients. Although a role for an RLS in triggering migraine remains speculative, several studies worldwide have found a close association between RLS and migraine, particularly in patients with a large RLS and migraine with aura . It may be that substances in the venous circulation, including circulating platelets, chemicals, and 5‐hydroxytryptamine, bypass the filter function of the pulmonary capillary bed by passing through the large cardiac defect and entering the brain, where they trigger a migraine attack …”

Section: Discussionmentioning

confidence: 99%

A New Perspective of Migraine Symptoms in Patients With Congenital Heart Defect

Liu

Wang

et al. 2018

Headache

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Objective To investigate the association between congenital heart defects (CHDs) and migraine and evaluate the efficacy of transcatheter defect closure from a new perspective. Methods The patients with CHDs who underwent transcatheter defect closure were screened in the medical database of Chinese PLA General Hospital from January 2006 to January 2017. The assessment included basic admission information, the 3‐item ID Migraine Screener, and a detailed questionnaire administered by telephone or in an outpatient clinic. Patients were divided into ventricular septal defect (VSD) group and AP group (ie, patients with ASD or PFO) based on the type of defects. The latter group could be further divided into right‐to‐left shunt (RLS) group and left‐to‐right (LRS) shunt group. Each group contained 4 subgroups according to their migraine diagnosis before and after defect closure: persistent migraine (PM), relieved migraine (RM), without migraine (WM), and new‐onset migraine (NM). Results The study recruited total 441 CHDs patients. Most patients in RLS group had migraine before and/or after surgery (76.4%, 42/55) and the proportion of them in NM group was higher than that of in LRS group (23.5%, 4/17 vs 6.8%, 18/266, P = .0418). Although the size of closure device or defect did not show significant differences, the ratios (R = size of closure/size of defect) were significantly higher in NM group than those in WM group (1.40 [1.26, 1.80] vs 1.22 [1.13, 1.38] in AP group, P = .00238; 1.38 [1.23, 1.50] vs 1.22 [1.13, 1.37] in LRS group, P = .024934, respectively). Further logistic regression analysis illustrated that larger R value was a risk factor for NM in AP group (OR 1.48, 95% CI 1.07–2.05, P = .0188). Besides, migraine symptoms decreased significantly after defect closure in PM group among patients with ASD and PFO. Conclusion This study revealed several associations between migraine and CHDs, especially the large ratio of closure device size to defect size. High‐quality randomized controlled trials and animal studies are needed to further investigate and clarify the underlying association between CHDs and migraine.

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Section: Discussionmentioning

confidence: 99%

A New Perspective of Migraine Symptoms in Patients With Congenital Heart Defect

Liu

Wang

et al. 2018

Headache

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“…RLS is an abnormal pathway between the venous and arterial circulations, and includes both intracardiac and extracardiac RLS. Intracardiac RLS are usually related to PFO, which has been described as a "back door to the brain" [17,18]. Hagen et al's autopsy study on 965 normal hearts found that PFO had a prevalence of 27.3% for all age [19].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and grade of RLS in migraine: a prospective study of 251 migraineurs by synchronous test of c-TTE and c-TCD

Zhao

Liu²,

Zhou

et al. 2020

Preprint

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Background RLS is considered as a risk factor for migraine, but the correlation between the RLS and migraine remains controversial. To investigate the prevalence and Right-to left shunt (RLS) grade of PFO in patients with migraine (including migraine with aura and without) and assess the association between PFO and migraine. Methods Synchronous test of contrast transthoracic echocardiography (c-TTE) and contrast transcranial Doppler ultrasonography (c-TCD) was conducted in 251 patients with migraine, including 61 migraine with aura (MA) and 189 migraine without aura (MO) and 275 healthy adults. Among these patients, 25 patients with migraine and 14 healthy adults were evaluated by transesophageal echocardiography (TEE). Results (1). The prevalence of permanent RLS, total RLS and large RLS in migraine was significantly higher compared with controls (P = 0.042, < 0.001 and 0.001, respectively). (2). Compared with controls, the positive rate of total RLS and large RLS in MO was increased (P = 0.004 and 0.022 respectively), the positive rate of permanent RLS, total RLS and large RLS in MA was also increased (P < 0.001 for each of the comparisons). The positive rate of permanent RLS and large RLS in MA was significantly higher than in MO (P = 0.004 and 0.011 respectively). (3) The presence of large-size PFO (≥ 2.0 mm) of migraine was higher than that of controls (P = 0.048). Conclusion PFO is associated with increased migraine (especially with aura), when the PFO is permanent RLS, large RLS and large-size PFO (≥ 2.0 mm).

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“…RLS was diagnosed based on the presence of at least one MB in the 20 s following the initiation of the procedure. We assessed the degree of shunt based on the amount of MBs detected in the Doppler spectrum using unilateral MCA monitoring as follows: mild shunt (1–10 MBs), moderate shunt (10–25 MBs), and large shunt (>25 MBs with shower or curtain patterns) (Wang et al, ) (Figure ). This assessment was performed by an experienced doctor who was blind to the patients' diagnoses.…”

Section: Methodsmentioning

confidence: 99%

“…There is a close association between migraine and right‐to‐left shunt (RLS), usually due to the presence of patent foramen ovale (PFO) (Ailani, ; Wang et al, ). Some studies have reported that the prevalence of RLS in migraine patients with aura (MA) and those without aura (MO) is 2.5‐fold and 1.4‐fold higher, respectively, than that found in healthy control subjects (Schwerzmann et al, ; Wang et al, ). A larger RLS is more common in MA and MO patients than in controls.…”

Section: Introductionmentioning

confidence: 99%

Clinical features of right‐to‐left shunt in the different subgroups of migraine

et al. 2020

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Objective Several investigations have documented an association between migraine and right‐to‐left shunt (RLS). However, whether there are specific clinical features that can distinguish between migraine patients with and without RLS is unclear. This study aims to explore whether there are specific clinical features that can distinguish between migraine patients with and without RLS, and to investigate the relationship between the degree of shunt and clinical parameters of headache. Methods In this study, we enrolled consecutive migraineurs who underwent a structured, standardized questionnaire for family and personal history and for detailed migraine features. RLS was diagnosed based on a contrast enhancement transcranial Doppler (c‐TCD) examination. Results Overall, 113 migraine with aura (MA) and 192 migraine without aura (MO) patients were included. Patients with MA and RLS (MARLS+) had a higher frequency for sensory aura symptoms than those with MA without RLS (MARLS−) (27.4% vs. 10.0%, p = .03). Patients with MO and RLS (MORLS+) presented with significantly younger initial age of migraine onset and experienced more severe pain intensity than those with MO without RLS (MORLS−) (mean ± SD, 25.6 ± 8.9 vs. 29.8 ± 12.7 years, p = .008 and 5.9 ± 1.4 vs. 5.3 ± 1.3, p = .006, respectively). There was no relationship between the degree of shunt and the clinical parameters of headache. Conclusions Our results indicate that MO patients presented with a younger initial age of migraine onset and that sensory aura symptoms in MA patients may predict the presence of RLS. However, we did not find support for relationship between the degree of shunt and clinical parameters of headache.

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Prevalence and extent of right-to-left shunt on contrast-enhanced transcranial Doppler in Chinese patients with migraine in a multicentre case-control study

Cited by 29 publications

References 24 publications

A New Perspective of Migraine Symptoms in Patients With Congenital Heart Defect

A New Perspective of Migraine Symptoms in Patients With Congenital Heart Defect

Prevalence and grade of RLS in migraine: a prospective study of 251 migraineurs by synchronous test of c-TTE and c-TCD

Clinical features of right‐to‐left shunt in the different subgroups of migraine

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