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Migraines Linked to Intrapulmonary Right-to-Left Shunt

Authors

  • John Thenganatt MD,

  • Jacob Schneiderman MD,

  • Robert H. Hyland MD,

  • John Edmeads MD,

  • Jennifer L. Mandzia BSc,

  • Marie E. Faughnan MD


  • From Division of Respirology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada (Dr. Thenganatt, Dr. Hyland, Mandzia, and Dr. Faughnan); Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada (Dr. Schneiderman); Division of Neurology, Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Canada (Dr. Edmeads).

Address all correspondence to Dr. Marie E. Faughnan, Division of Respirology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Room 6049, Toronto, ON, Canada M5B 1W8.

Abstract

Objective.—To determine if there is an association between migraines and intrapulmonary right-to-left shunt.

Background.—Several studies have described an association between migraines and intracardiac right-to-left shunt.

Methods.—Patients with hereditary hemorrhagic telangiectasia (HHT) were retrospectively recruited from the Toronto Hereditary Hemorrhagic Telangiectasia Center Clinical Database. All patients had been prospectively, systematically asked about a history of migraines and systematically screened for pulmonary and cerebral arteriovenous malformations (AVMs). All patients with a definite diagnosis of HHT, assessed during a 2-year period (February 1997 to April 1999), were included. Univariate analyses and logistic regression were performed, for migraine as the dependent variable and the following independent variables: age, sex, pulmonary AVMs, and cerebral AVMs.

Results.—Of the 200 patients assessed during the 2-year period, 124 (62%) had a definite diagnosis of HHT and were included in the analysis. Eighty (65%) were females. Forty-seven (38%) of the HHT patients had a history of migraine, of whom 38 (81%) had migraine with aura. The prevalence of migraine was greater in patients with pulmonary AVMs (46%) compared to patients without pulmonary AVMs (33%), OR = 1.7 (0.8 to 3.6), though this did not reach statistical significance (P= .14). Pulmonary AVMs were significantly associated with migraine (OR = 2.4, 95% CI = 1.1 to 5.5, P= .04), after adjustment for age and sex, using logistic regression.

Conclusions.—There is a significant association between intrapulmonary right-to-left shunt and migraine.

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