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Evaluating the relationship between right-to-left shunt and white matter hyperintensities in migraine patients: A
Joshua Y P Yeo1, Claire X Y Goh2, Ying Kiat Tan2
1Department of Medicine, National University Health System, Singapore, Singapore.
Introduction:
White matter hyperintensities (WMHs) have been observed with greater frequency in patients with migraine and are thought to be associated with impaired cognition and function. The relationship between WMHs and right-to-left shunt (RLS) in migraine patients is unknown. We performed a systematic review to determine if there is an association between RLS and WMHs in patients with migraine.
Methods:
A systematic search of the literature was performed in PubMed and Embase using a suitable keyword search strategy from inception up to 16th June 2021. All studies that included patients with migraine and studied RLS and WMHs were included.
Results:
A total of 8 non-randomized observational studies comprising 1125 patients with migraine were included; 576 had an RLS, compared to 549 patients with no RLS. The mean age of the study populations ranged from 28.4 to 43 years, while the average duration from migraine diagnosis ranged from 5.1 to 19 years. The proportion of female to male patients was consistently higher in all studies (60.0-94.4%). Amongst migraine patients with RLS, 338 patients (58.7%) had WMHs. In contrast, 256 (46.6%) of migraine patients without RLS had WMHs. RLS was significantly associated with the presence of WMHs in migraine patients (OR: 1.56, 95% CI: 1.05-2.34, p = 0.03).
Conclusion:
In migraine patients, RLS was significantly associated with the presence of WMHs. Longitudinal studies are warranted to establish RLS as a risk factor for WMHs in patients with migraine, and to establish the significance of these changes.
Insights
Right-to-left shunt (RLS) is associated with white matter hyperintensities (WMHs) in migraine patients. Further research is needed to confirm RLS as a risk factor for WMHs in this population.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Neurology
Background:
- White matter hyperintensities (WMHs) are linked to cognitive decline in migraine patients.
- The association between right-to-left shunt (RLS) and WMHs in migraine is not well understood.
Approach:
- A systematic review of 8 non-randomized observational studies involving 1125 migraine patients was conducted.
- Literature search performed in PubMed and Embase up to June 16, 2021.
Key Points:
- Migraine patients with RLS showed a higher prevalence of WMHs (58.7%) compared to those without RLS (46.6%).
- RLS was significantly associated with the presence of WMHs in migraine patients (OR: 1.56, 95% CI: 1.05-2.34, p = 0.03).
Conclusions:
- A significant association exists between RLS and WMHs in migraine patients.
- Longitudinal studies are recommended to establish RLS as a potential risk factor for WMHs in migraine.
