Prevalence and grade of RLS in migraine

Abstract

Background: Right-to left shunt (RLS) is regarded as a risk factor resulting in migraine, but the relevance between the RLS and migraine remains controversial. This paper aims at investigating the prevalence and RLS grade of patent foramen ovale (PFO) in cases of migraine (including migraine with and without aura) and evaluate the relationship between PFO and migraine. Methods: Synchronous test of contrast transthoracic echocardiography and contrast transcranial Doppler ultrasonography was performed in 251 cases of migraine, which contains 62 cases of migraine with aura (MA) and 189 cases without aura (MO) and 275 healthy adults. Among these cases, 25 cases with migraine and 14 healthy adults were evaluated through transesophageal echocardiography. Results: (1). The prevalence of permanent RLS, total RLS, and large RLS in migraine was 11.16%, 39.04%, and 17.13%, respectively, which was significantly higher than that of the controls ( P = .042, <.001, and.001, respectively). (2). Permanent RLS was detected as 7.93% of the cases in MO, 20.96% in MA, and 6.18% in controls. Total RLS was detected as 35.98% of the cases in MO, 48.38% in MA, and 23.64% in controls. Large RLS was detected as 13.76% of the cases in MO, 27.41% in MA, and 7.27% in controls. Compared with controls, the positive rate of total RLS and large RLS in MO increased ( P = .004 and.022, respectively), the that of permanent RLS, total RLS, and large RLS in MA also increased ( P < .001 for each of the comparisons). The positive rate of permanent RLS and large RLS in MA was remarkably higher than that in MO ( P = .005 and.013, respectively). (3) The presence of large-size PFO (≥2.0 mm) of migraine showed higher than that of the controls ( P = .048). Conclusions: PFO is associated with the migraine (especially with aura), when it is permanent RLS, large RLS, and large-size PFO (≥2.0 mm).

The Influence of Patent Foramen Ovale on the Clinical Features of Migraine without Aura: A Cross-Sectional Study

“…Next, we compared the clinical features of the patients with mild RLS and moderate to large RLS. As shown in Table 2, the VAS scores were significantly higher in patients with moderate to large RLS [8 (IQR,[7][8][9]] than in patients with mild RLS [7 (IQR,[6][7][8], p = 0.002]. The frequency of headache, episode duration, HIT-6 score, EUROHIS-QOL 8 score, and the incidence of WML were not different (all p> 0.05).…”

“…Recent evidence suggests a correlation between the presence of patent foramen ovale (PFO) and MA. 7 PFO is present in 20% to 25% of the general population, 8,9 but the prevalence of PFO in patients with MA is more than twice as high as that in the general population. 8,10 More importantly, MA patients with moderate or large PFO have significantly higher frequencies of headaches, Headache Impact Test (HIT-6) scores, and migraine disability assessment scores (MIDAS) than those with mild PFO or without PFO.…”

“…7 PFO is present in 20% to 25% of the general population, 8,9 but the prevalence of PFO in patients with MA is more than twice as high as that in the general population. 8,10 More importantly, MA patients with moderate or large PFO have significantly higher frequencies of headaches, Headache Impact Test (HIT-6) scores, and migraine disability assessment scores (MIDAS) than those with mild PFO or without PFO. 11 The frequency and duration of headaches can effectively be reduced, and the quality of life can be improved after PFO closure treatment.…”