The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study

Iwasaki, Atsushi; Suzuki, Keisuke; Takekawa, Hidehiro; Takashima, Ryotaro; Suzuki, Atsushi; Suzuki, Shigeaki; Hirata, Koichi

doi:10.1186/s10194-016-0714-x

Cited by 14 publications

(11 citation statements)

References 36 publications

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“…Disease duration and attack frequency, as reported in the literature (9,24), were found to have no association with DWMHs in our study. Contrary to what we expected, we found a negative association with family history.…”

Section: Migraine Featuressupporting

confidence: 57%

“…The association between RLS and WMHs in migraine patients has long been debated. The majority of published papers have reported no association between RLS and WMHs (7,9,23); however, some research has shown a positive association (24,25). There is evidence that migraine patients have a higher prevalence of RLS (9, 10), and it is believed that paradoxical embolism caused by RLS is related to cryptogenic stroke and silent brain infarcts in migraine (26).…”

Section: Rls and Dwmhs In Migrainementioning

confidence: 99%

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Association between Deep White Matter Hyperintensities and Right-to-left Shunt in Migraine (CAMBRAIN): A Cross-sectional Multicenter Study

Xing

Zhang

Zhao

et al. 2021

Preprint

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BackgroundDeep white matter hyperintensities (DWMHs), often identified by hyperintense lesions on T2-weighted magnetic resonance imaging (MRI), were discovered to have a higher prevalence in migraine patients. A right-to-left shunt (RLS), which is also prevalent in migraineurs, could potentially contribute to the formation of DWMHs by induction of controversial embolism and endothelial dysfunction. In this cross-sectional study, we aim to evaluate the association between RLS and the prevalence of DWMHs in patients with migraine.MethodsIn this study, we consecutively enrolled patients with migraine aged between 18 and 50 years from the 14 headache clinics of participating hospitals. DWMHs were rated using Scheltens scale on digital MRI images obtained from 1.5T scanners, and RLS was detected via contrast-enhanced transcranial Doppler. Analyses on DWMH prevalence and loads by RLS grading or subtype were performed. A logistic regression analysis on DWMH prevalence was also performed.ResultsIn all, 237 migraine patients (age: 39.3 ± 11.7, 78.1% women, 13% migraine with aura) were enrolled. RLS was detected in 48.5% of the subjects and DWMHs were identified in 138 (58.2%) patients. Prevalence of DWMHs did not differ significantly between RLS+ (57.4%) and RLS− patients (59.0%, p = 0.74). No statistical difference in DWMH loads was found between different RLS grades or subtypes. Instead of RLS grades (p = 0.75), age (OR 1.067; 95%CI 1.034–1.101; p < 0.001) and aura (OR 4.063; 95%CI 1.492–11.061; p = 0.006) were statistically significant independent risk factors for increased DWMH prevalence in migraine patients.ConclusionsOur findings do not support an association between RLS and DWMHs in migraine patients, regardless of RLS grades or subtypes.Clinical Trial Registration: NCT 03418766; Date of registration: February 1, 2018

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Section: Migraine Featuressupporting

confidence: 57%

Section: Rls and Dwmhs In Migrainementioning

confidence: 99%

Association between Deep White Matter Hyperintensities and Right-to-left Shunt in Migraine (CAMBRAIN): A Cross-sectional Multicenter Study

Xing

Zhang

Zhao

et al. 2021

Preprint

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“…Our findings based on retrospective observation suggest a significant relationship between PFO and near- reported that right to left shunt is an independent risk factor for WMLs in migraine patients 16 , though further analysis of the WMLs was not carried out.…”

Section: Discussionmentioning

confidence: 67%

“…Emboli block microcirculation and cause local blood flow hypoperfusion 15 . In 2017, Farzianpour's study of 107 Japanese migraine patients reported that right to left shunt is an independent risk factor for WMLs in migraine patients 16 , though further analysis of the WMLs was not carried out.…”

Section: Discussionmentioning

confidence: 99%

A Study on the Relationship Between Patent Foramen Ovale and White Matter Lesions in Migraine Patients

Huo¹,

Wan²,

Li³

et al. 2021

Preprint

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Background Migraine is a common clinical primary headache with unclear aetiology. In recent years, studies have shown that migraine is related to patent foramen ovale, and some patients with migraine have white matter lesions. However, the relationship among the three is unclear.Objective To explore the characteristics of white matter lesions (WMLs) in migraine patients with patent foramen ovale and to predict the occurrence of patent foramen ovale through magnetic resonance imaging (MRI) characteristics in patients with migraine.Methods Seventy-seven patients clinically diagnosed with migraine were examined by transcranial Doppler ultrasound (cTCD) and MRI. The patients were grouped according to the presence of WMLs, with matching by age, sex, hypertension, diabetes, PFO and other characteristic data. We observed the MRI fluid attenuation inversion recovery sequence (FLAIR) image and compared and analysed the difference in WMLs between the PFO-positive group and the PFO-negative group.Results There were 42 cases and 35 cases of migraine with and without WMLs, respectively. A statistically significant difference in near-cortical WMLs with PFO in migraine patients was observed (P=0.001). Logistic regression analysis adjusted by age, sex, hypertension and diabetes identified PFO status as the sole determinant for the presence of near-cortical WMLs (OR = 0.14; 95%CI 0.045–0.421; p < 0.001)Conclusion Near-cortical white matter lesions in migraine patients are related to PFO. Transcranial Doppler ultrasonography may reveal more PFO in patients with migraine and near-cortical WMLs.

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“…while several studies did not show an association between the presence of RLS and WMH [52][53][54][55], some studies reported an association between RLS and certain types of WMHs in migraineurs [56][57][58].…”

Section: Factors Associated With Wmh In Migraineursmentioning

confidence: 93%

White matter hyperintensities in migraine: a review

2019

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Migraine is a neurological disorder characterized by recurrent spells of headache accompanied by brain symptoms such as nausea, vomiting, photophobia, and phonophobia. White matter hyperintensity (WMH) is the most frequent radiological abnormality observed in migraineurs. Older studies have reported that the prevalence of WMH is about 30% in migraineurs, while latest studies using advanced technology show that WMHs are present in about 70% of young (age < 50 years), vascular risk factor-free patients with migraine. Population-based studies on elderlies reported conflicting results on the association between migraine and WMH, but deep WMHs were greater in studies of the younger population. Data are also conflicting on whether headache characteristics, migraine type, disease duration, or headache frequency are associated with WMH. Current evidence suggests that a greater deep WMH burden is associated with intracranial and extracranial vascular function. The clinical implication of WMH has not been well studied in relation to migraine, but it is generally not associated with cognitive dysfunction in patients with migraine. Current understanding of WMHs is limited; we herein suggest some tips for improvement in research methods that will bring a better understanding of both the pathophysiology and the consequence of WMH development in patients with migraine.

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The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study

Cited by 14 publications

References 36 publications

Association between Deep White Matter Hyperintensities and Right-to-left Shunt in Migraine (CAMBRAIN): A Cross-sectional Multicenter Study

Association between Deep White Matter Hyperintensities and Right-to-left Shunt in Migraine (CAMBRAIN): A Cross-sectional Multicenter Study

A Study on the Relationship Between Patent Foramen Ovale and White Matter Lesions in Migraine Patients

White matter hyperintensities in migraine: a review

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