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Relationship between right-to-left shunt and white matter lesions in patients with migraine: a single-center study
Zhihong Liu1, Mingzhu Jiang2, Jing He2
1Department of Neurology, Xiuwen County People's Hospital, Guiyang, China.
Background:
Migraine patients have an increased long-term risk of cardio and cerebrovascular events. However, whether these patients are more susceptible to white matter lesions (WMLs) remains debated. To explore this question, our study assessed the proportion of RLS in migraine patients and explored the association between right-to-left shunt (RLS) and WMLs.
Methods:
In this study, we included 998 migraine patients. Contrast transcranial doppler (c-TCD) was used to diagnose RLS and assess the extent of the shunt in RLS patients. Of the 998 patients, 505 underwent cranial magnetic resonance imaging (MRI) assessments. WMLs were classified into periventricular white matter lesions (pvWMLs) and deep white matter lesions (dWMLs).
Results:
Among the 998 migraine patients, 946 had migraine without aura (MO; mean age 36.68 ± 10.46 years; 80.5% female), and 52 had migraine with aura (MA; mean age 29.85 ± 8.59 years; 71.2% female). Compared with MO patients, MA patients had an earlier onset age (23.1 ± 7.97 vs. 28.44 ± 10.38 years, p < 0. 001) and a shorter disease duration (6.76 vs. 8.34 years, p = 0.024). The overall proportion of RLS patients was 41.9%, with a greater proportion of RLS patients in the MA group than in the MO group (55.8% vs. 41. 1%, p = 0.037). The percentage of RLS-positive patients with no/small shunt was greater in the MO group than in the MA group (81.5% vs. 65.4%, p = 0.004), whereas the percentage of RLS-positive patients with moderate/large shunt was greater in the MA group (34.6% vs. 18.5%, p = 0.024). The proportion of RLS patients was lower in the WML-positive group (n = 173) than in the WML-negative group (n = 332), but the difference was not significant (40.5% vs. 45.8%, p = 0.253).
Conclusion:
This study revealed that 41.9% of migraine patients had RLS, and the proportion of RLS patients was 41. 1% in the MO group and 55.8% in the MA group. The rate of RLS positivity in migraine patients may not be related to the incidence of WMLs.
Insights
Migraine patients have a 41.9% rate of right-to-left shunt (RLS). This study found no significant association between RLS and white matter lesions (WMLs) in migraineurs, suggesting RLS may not increase WML risk.
Area of Science:
- Neurology
- Cardiovascular Research
Background:
- Migraine is linked to increased long-term risk of cardio and cerebrovascular events.
- The association between migraine and white matter lesions (WMLs) remains debated.
- This study investigates the prevalence of right-to-left shunt (RLS) in migraine patients and its relationship with WMLs.
Purpose of the Study:
- To determine the proportion of migraine patients with RLS.
- To explore the association between RLS and the presence of WMLs in migraine patients.
Main Methods:
- Included 998 migraine patients, diagnosed using contrast transcranial doppler (c-TCD).
- Assessed WMLs via cranial magnetic resonance imaging (MRI) in 505 patients.
- Classified WMLs into periventricular white matter lesions (pvWMLs) and deep white matter lesions (dWMLs).
Main Results:
- Overall, 41.9% of migraine patients had RLS.
- Migraine with aura (MA) patients showed a higher proportion of RLS (55.8%) compared to migraine without aura (MO) patients (41.1%).
- No significant difference in RLS prevalence was observed between WML-positive (40.5%) and WML-negative (45.8%) migraine patients.
Conclusions:
- The prevalence of RLS in migraine patients is substantial (41.9%).
- RLS positivity in migraine patients does not appear to be directly related to the incidence of WMLs.
- Further research is needed to clarify the complex relationship between migraine, RLS, and cerebrovascular health.
