From the Department of Cardiology, Royal Shrewsbury Hospital, Shrewsbury, UK (Dr. Wilmshurst); and Department of Neurology, Royal Shrewsbury Hospital, Shrewsbury, UK (Dr. Nightingale).
The Role of Cardiac and Pulmonary Pathology in Migraine: A Hypothesis
Article first published online: 9 MAR 2006
Headache: The Journal of Head and Face Pain
Volume 46, Issue 3, pages 429–434, March 2006
How to Cite
Wilmshurst, P. and Nightingale, S. (2006), The Role of Cardiac and Pulmonary Pathology in Migraine: A Hypothesis. Headache: The Journal of Head and Face Pain, 46: 429–434. doi: 10.1111/j.1526-4610.2006.00374.x
- Issue published online: 9 MAR 2006
- Article first published online: 9 MAR 2006
- Accepted for publication December 20, 2005.
- migraine with aura;
- persistent foramen ovale;
- pulmonary arteriovenous fistula;
- decompression illness
From observation of recent data linking migraine with right-to-left shunts and by analogy with the etiologies of decompression illness, we postulate that cardiac and pulmonary pathology can have an important effect on the cranial final common pathway that generates attacks of migraine. One possible mechanism is associated with a significant right-to-left shunt, which is usually through a persistent foramen ovale, but is sometime through a pulmonary shunt. This allows a venous agent, possibly 5-hydroxytryptamine, to bypass the lung filter. Migraine can occur when there is no shunt if similar agents are liberated in the left heart beyond the lung filter, possibly by platelet activation. Migraine could also occur if the venous agents are produced in such large amounts that they overwhelm the pulmonary filter or are unaffected by passage through the lungs. In some individuals migraine may be unrelated to blood-borne triggers.