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Embolization of pulmonary arteriovenous malformations and decrease in prevalence of migraine.

M C Post1, V Thijs, W J Schonewille

  • 1Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. m.post@antonius.net

Neurology
|January 26, 2006
PubMed
Summary
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Embolizing pulmonary arteriovenous malformations (PAVMs) in hereditary hemorrhagic telangiectasia (HHT) patients significantly reduced migraine prevalence. This suggests right-to-left shunts, not their location, may cause migraine in HHT.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Genetics

Background:

  • Hereditary hemorrhagic telangiectasia (HHT) is associated with pulmonary arteriovenous malformations (PAVMs).
  • Migraine is a common neurological disorder with various potential triggers.
  • The link between PAVMs and migraine in HHT patients requires further investigation.

Purpose of the Study:

  • To investigate the effect of PAVM embolization on migraine occurrence in HHT patients.
  • To determine if reducing right-to-left shunts impacts migraine prevalence and severity.

Main Methods:

  • A cohort of 105 HHT patients aged 16+ who underwent PAVM embolization were studied.
  • Headache questionnaires assessed migraine 1 year pre- and 6+ months post-embolization.
  • Migraine diagnoses were confirmed by two independent neurologists using International Headache Society criteria.

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Main Results:

  • Migraine prevalence decreased from 45.2% to 34.5% (p=0.01) post-embolization.
  • Migraine with aura prevalence significantly dropped from 33.3% to 19.0% (p=0.002).
  • Headache severity showed a downward trend in persistent migraine cases, though not statistically significant.

Conclusions:

  • PAVM embolization in HHT patients correlates with a reduced prevalence of migraine.
  • The findings suggest that right-to-left shunting, rather than shunt location, may be a key factor in migraine pathogenesis.
  • This implies that treating PAVMs could be a therapeutic strategy for migraine in HHT.