Right-to-left shunt is common in chronic migraine
Corresponding Author
SJ Nahas
Thomas Jefferson University Hospital, Department of Neurology and
Stephanie J Nahas, 111 S. 11th St., Suite 8130, Philadelphia, PA 19107, USA. Tel. + 1-215-955-2031, fax + 1-215-955-1960, e-mail [email protected]Search for more papers by this authorWB Young
Thomas Jefferson University Hospital, Department of Neurology and
Search for more papers by this authorAJ Guarino
Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
Search for more papers by this authorSD Silberstein
Thomas Jefferson University Hospital, Department of Neurology and
Search for more papers by this authorCorresponding Author
SJ Nahas
Thomas Jefferson University Hospital, Department of Neurology and
Stephanie J Nahas, 111 S. 11th St., Suite 8130, Philadelphia, PA 19107, USA. Tel. + 1-215-955-2031, fax + 1-215-955-1960, e-mail [email protected]Search for more papers by this authorWB Young
Thomas Jefferson University Hospital, Department of Neurology and
Search for more papers by this authorAJ Guarino
Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
Search for more papers by this authorSD Silberstein
Thomas Jefferson University Hospital, Department of Neurology and
Search for more papers by this authorAbstract
Our aim was to determine the prevalence of right-to-left shunt (RtLS) in patients with chronic migraine (CM), and to correlate the presence and grade of RtLS with aura and neurological symptoms, and duration and severity of disease. The prevalence of RtLS in migraine without aura is similar to that of the general population (between 20 and 35%). In migraine with aura, the prevalence is much higher (approximately 50%). The prevalence in CM, with or without aura, is unknown. Consecutive patients between the ages of 18 and 60 years with CM attending a tertiary care specialty headache clinic over an 8-week period were eligible. There were 131 patients in the study. A structured diagnostic interview was performed. Bubble transcranial Doppler with Valsalva manoeuvre determined RtLS presence and grade. Sixty-six percent (86/131) of patients had RtLS, a statistically significantly greater rate than those reported in the general population and in migraine with or without aura (P < 0.001). There was no difference in RtLS rate or grade between those with and those without aura. Specific headache features and the presence of neurological symptoms were similar between those with and those without RtLS. Compared with both the general population and the episodic migraine population (with and without aura), patients with CM, with or without aura, are more likely to have RtLS. The clinical implications of our findings need to be determined.
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