Relationship between non-headache symptoms and right to left shunt in episodic migraine. A single-center cross-sectional study |
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| Institution: | 1. Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand;2. Department of Surgery, University of Melbourne, Parkville, Victoria, Australia;3. Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia;4. Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Victoria, Australia;5. Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia;6. Centre for Eye Research Australia, Melbourne, Victoria, Australia;7. Shiley Eye Institute, University of California, San Diego, CA, United States;8. Department of Neurosurgery, Hadassah Hebrew University Medical Centre, Jerusalem, Israel;1. Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;2. Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;3. Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;4. Department of General Internal Medicine, JCHO Sendai Hospital, Sendai, Miyagi, Japan;1. Ac?badem University School of Medicine, Department of Endocrinology, ?stanbul, Turkey;2. Koç University Hospital, Department of Neurosurgery, Istanbul, Turkey;3. Ac?badem Mehmet Ali Ayd?nlar University, School of Medicine, Medical Biotechnology, Istanbul, Turkey;4. Ac?badem Mehmet Ali Ayd?nlar University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey;5. Koç University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey;1. Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China;2. Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China |
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| Abstract: | The relationship between right to left shunt (RLS) and non-headache symptoms (NHS) in episodic migraine is unknown. This study aimed to investigate the incidence and classification of RLS in episodic migraineurs, calculate the occurrence rate of NHS, and analyze the associations between RLS and NHS. We consecutively recruited 204 episodic migraine patients. Contrast-enhanced transcranial doppler was adopted to screen RLS. Structured questionnaire via face-to-face survey was conducted to collect clinical data. A total of 172 episodic migraineurs were included in the final analysis, of which 20 cases were migraine with aura. The positive rate of RLS was 47.1%, of which 50 cases (29.0%) had small shunt (Grade 1) and 31 cases (18.1%) had mid-large shunt (Grade 2–4). The most common NHS was nausea (115 (66.9%)), followed by headache aggravation with physical activity (96 (55.8%)), dizziness (93 (54.1%)), vomiting (77 (44.8%)) and phonophobia (74 (43.0%)). Yawning was more common in Grade 2–4 group than Grade 0 group (p = 0.012), while no statistical differences among other groups. Grade 2–4 group had a higher rate of headache aggravation with physical activity than grade 0 group (p = 0.008). Binary logistic regression analysis showed that yawning at premonitory phase, headache aggravation with physical activity and cranial autonomic symptoms during attack are independent predictors of RLS. In conclusion, yawning and headache aggravation with physical activity are more common in migraine patients with RLS. Besides aura, particular NHS may also serve as indicators for screening RLS in episodic migraineurs. |
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| Keywords: | Migraine Right to left shunt Non-headache symptoms Headache aggravation with physical activity Yawning |
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