title: A pulmonary right-to-left shunt in patients with hereditary hemorrhagic telangiectasia is associated with an increased prevalence of migraine.
abstract: BACKGROUND
  Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal-dominant vascular dysplasia with a high prevalence of pulmonary arteriovenous malformation (PAVM). Recent studies report an increased prevalence of migraine in patients with a cardiac right-to-left shunt. The aim of our study was to evaluate whether there is also an increased prevalence of migraine in patients with a pulmonary right-to-left shunt (PAVM).
  
  
  METHODS
  All patients with HHT referred to our hospital till April 2004 with or without PAVM and with or without migraine were included in the study.
  
  
  RESULTS
  In total, 538 HHT patients (41.6% men; mean age +/- SD, 39.3 +/- 18.6 years) could be included. PAVM was present in 208 patients (38.7%; mean age, 39.3 +/- 17.6 years). Significantly more women were present in the PAVM subgroup compared to the non-PAVM subgroup, 65.4% vs 53.9% (p = 0.009). Migraine occurred in 88 patients with HHT, a prevalence of 16.4%. The prevalence of migraine in women with HHT was significantly higher compared to men, 19.4% vs 12.1%, respectively (p = 0.03) The prevalence of migraine in patients with PAVM was 21.2%, which was significantly higher then in patients without PAVM, 13.3% (p = 0.02). The occurrence of PAVM in the patients with migraine is significantly higher than in those without migraine, 50.0% vs 36.4%, respectively (p = 0.02).
  
  
  CONCLUSIONS
  This study showed a higher prevalence of PAVM in patients with migraine and HHT. The right-to-left shunt due to the PAVM might play a causal role in the pathogenesis of migraine in patients with HHT. This needs to be determined in further studies.
authors.affiliation: Department of Cardiology, St. Antonius Hospital., 3435 CM Nieuwegein, Netherlands.
authors.forename: Martijn C
authors.initials: MC
authors.lastname: Post
authors.forename: Tom G W
authors.initials: TG
authors.lastname: Letteboer
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Mager
authors.forename: Thijs H
authors.initials: TH
authors.lastname: Plokker
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: Cornelius J J
authors.initials: CJ
authors.lastname: Westermann
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology*; D011183:Postoperative Complications / Q000503:physiopathology; D015995:Prevalence; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*; D011667:Pulmonary Veins / Q000002:abnormalities / Q000601:surgery*; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000145:classification / Q000150:complications / Q000601:surgery*