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

Abstract

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).

Contrast-enhanced transcranial doppler versus contrast transthoracic echocardiography for right-to-left shunt diagnosis

“…This explains why it was difficult to detect shunts with c-TTE when c-TCD was a provoked shunt. Some scholars have proposed that the simultaneous execution of c-TCD and c-TTE can prevent errors caused by ineffective Valsalva maneuvers and improve the detection rate of c-TTE [ 18 ]. When the results of c-TCD and c-TTE were inconsistent, only one patient tested negative for c-TCD but positive for c-TTE.…”

The value of right heart contrast echocardiography combined with migraine rating scale in evaluating the efficacy of patent foramen ovale closure

“…Combined with the Valsalva maneuver, cTTE examination can be used to assess the closure of the foramen ovale by performing contrast imaging of the right heart, to observe whether any microbubbles enter the left atrium through the unclosed foramen ovale after the full opacification of right atrium. It can not only display the structure of the foramen ovale but also quantify RLS by observing the number of microbubbles in the left atrium [ 5 ]. However, whether the RLS result displayed by cTTE is related to the severity of migraine, as well as the value of cTTE in the follow-up of interventional occlusion needs to be further studied.…”

“…The application of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) has greatly improved the accuracy of the diagnosis of PFO, but the sensitivity of RLS examination is relatively low. It has been confirmed that contrast transthoracic echocardiography (cTTE) can dynamically display the presence or absence of RLS in PFO in real-time, and can quantitatively assess the flow volume of RLS [ 5 ]. However, whether the RLS results displayed by cTTE are associated with the severity of migraine and its value in the follow-up of interventional occlusion needs to be further studied.…”

The Patent Foramen Ovale and Migraine: Associated Mechanisms and Perspectives from MRI Evidence

“…This suggests that PFO is significantly correlated with migraine, especially migraine with aura. In a prospective study, Zhao et al described that the prevalence of large RLS, large-size PFO (≥2.0 mm), and permanent RLS in migraine patients with aura was higher than that in healthy controls [ 23 ]. Meanwhile, Tang et al [ 24 ] recently found that the prevalence of migraine without aura in the PFO group was significantly higher than that in the group without PFO, so PFO was also closely related to migraine without aura.…”