Page 67 - Migraine, the heart and the brain

Table e-1. MRI ndings by RLS type, Odds ratio unadjusted [OR] and adjusted [OR]
Right-to-left shunts and migraine
Spontaneous RLS
Any silent brain infarct
Multiple silent brain infarcts
Silent infarct posterior circulation Infratentorial hyperintense lesions High volume deep white matter lesions
Total RLS
Any silent brain infarct
Multiple silent brain infarcts
Silent infarct posterior circulation Infratentorial hyperintense lesions High volume deep white matter lesions
OR unadjusted
OR 0.8 (0.3-1.9) OR 0.6 (0.1-2.8) OR 1.1 (0.3-3.6) OR 1.6 (0.8-3.5) OR 1.2 (0.6-2.4)
OR 1.5 (0.7-3.2) OR 3.0 (0.8-11.5) OR 2.8 (0.9-9.3) OR 0.8 (0.4-1.7) OR 1.4 (0.7-2.6)
Model 1
OR adjusteda
OR 0.9 (0.4-2.3) OR 0.8 (0.2-4.3) OR 1.5 (0.4-5.2) OR 1.9 (0.9-4.3) OR 1.4 (0.7-3.0)
OR 1.5 (0.7-3.3) 3 OR 3.2 (0.8-12.9)
OR 3.0 (0.9-10.0)
OR 0.8 (0.4-1.6)
OR 1.4 (0.7-2.7)
Abbreviations: RLS, Right-to-left shunts; Any silent brain infarct indicates infarct in any vascular territory. Multiple silent brain infarcts indicate more than one infarct in any vascular territory.
High volume deep white matter lesions de ned as upper 20th percentile
a Model 1: adjustments for diagnosis of migraine and age.
disCussion
We assessed and correlated (1) presence, type, and size of RLS, (2) presence and type of ischemic brain lesions on MRI, and (3) persistent migraine activity in a large and unbiased general population-based cohort of phenotypically well characterized migraineurs and controls. We found, rst, that in particular large-sized RLS are more prevalent among migraineurs with aura but not in migraineurs without aura. Second, migraineurs with aura and spontaneous RLS more often had ongoing migraine activity compared to migraineurs with aura without RLS or migraineurs without aura with or without RLS. Third, participants with RLS did not have more silent infarcts in the posterior cerebral circulation, irrespective of whether or not they also had migraine. There was no association of RLS with white matter lesions.
Our nding that RLS are more prevalent in migraineurs with aura from the general population is well in line with observations from clinic-based studies4,6 and extends the RLS-migraine association from selected severe cases who are attending headache clinics to the average patient with migraine with aura. Two previous population-based studies, however, failed to nd an association between RLS and migraine,25,26 most likely due to limited statistical power, use of detection methods with only limited sensitivity to identify RLS, and, possibly, selection bias. In the rst study,25 79% of participants had migraine withaura,whereas in the general population
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