Prevalence of right-to-left shunts on transcranial Doppler in chronic migraine and medication-overuse headache

• Published in: Cephalalgia 2014-01, Vol.34 (1), p.37-41
• Main Authors: Guo, Song, Shalchian, Sarvnaz, Gérard, Pascale, Küper, Michael, Katsarava, Zaza, Ashina, Messoud, Schoenen, Jean
• Format: Article
• Language: English
• Subjects: Adult; Chronic Disease; Comorbidity; Europe - epidemiology; Female; Foramen Ovale, Patent - diagnostic imaging; Foramen Ovale, Patent - epidemiology; Headache Disorders, Secondary - diagnostic imaging; Headache Disorders, Secondary - epidemiology; Humans; Male; Middle Aged; Migraine Disorders - diagnostic imaging; Migraine Disorders - epidemiology; Prevalence; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Ultrasonography, Doppler, Transcranial - statistics & numerical data
• ISSN: 0333-1024; 1468-2982
• DOI: 10.1177/0333102413497600

Background It was suggested that right-to-left shunt (RLS) may be highly prevalent in chronic migraine (CM) patients, indicating that patent foramen ovale (PFO) might be an aggravating and chronifying factor of migraine. Since a high proportion of chronic migraineurs also have medication-overuse headache (MOH), one may wonder if they have a more severe form of the disorder and more frequently a PFO. Objective The objective of this study is to determine the prevalence and grade of RLS in patients suffering from CM and MOH. Methods A cross-sectional multicenter study of air-contrast transcranial Doppler was conducted in 159 patients with CM (n = 57) or MOH (n = 102) attending a tertiary headache clinic. Results The prevalence of RLS in CM was 37% (11% large shunts) and in MOH patients 31% (13% large shunts). There was no difference between the two groups (p = 0.49). Conclusion RLS prevalence in CM is within the upper range of those reported in episodic migraine without aura or in the general population, and not higher in MOH. PFO is thus unlikely to have a significant causal role in these chronic headaches.