title: Systemic right-to-left shunts, ischemic brain lesions, and persistent migraine activity.
abstract: To assess whether migraine in the general population is associated with increased risk of systemic right-to-left shunts (RLS) and whether RLS are associated with increased prevalence of brain infarcts and persistent recurrence of migraine attacks at older age.
  
  
  
  Brain MRI and transcranial Doppler with air contrast in 166 unselected migraineurs (mean age ± SD 56 ± 7.7 years; 70% women; n = 96 migraine with aura) and 69 controls (mean age ± SD 55 ± 7.6 years; 65% women) from the general population.
  
  
  
  Participants with migraine with aura more frequently had Valsalva-induced RLS (60%), in particular large-sized, compared to controls (42%; odds ratio [OR] 2.1; 95% confidence interval [CI] 1.1-3.9; p = 0.02) and participants with migraine without aura (40%; OR 2.3; 95% CI 1.2-4.3; p = 0.01). They also more frequently had spontaneous RLS (35%) than participants with migraine without aura (17%; OR 2.6; 95% CI 1.3-5.6; p = 0.01) but not compared to controls (26%; OR 1.6; 95% CI 0.8-3.1; p = 0.2). Participants with migraine with aura and spontaneous RLS more frequently had persistent migraine activity (85%) than participants with migraine without spontaneous RLS (63%; OR 3.4; 95% CI 1.2-10.1; p = 0.03). Nine percent of participants with RLS had silent posterior circulation infarcts compared to 3% of participants without RLS (OR 2.8; 95% CI 0.9-9.3; p = 0.08), independent of migraine status. RLS were not associated with white matter lesions.
  
  
  
  RLS are more prevalent in migraineurs with aura but do not explain the increased prevalence of silent posterior circulation infarcts or white matter lesions in migraineurs. Spontaneous RLS are associated with persistent migraine.
authors.affiliation: From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD. h.koppen@hagaziekenhuis.nl.
authors.forename: Hille
authors.initials: H
authors.lastname: Koppen
authors.affiliation: From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.
authors.forename: Inge H
authors.initials: IH
authors.lastname: Palm-Meinders
authors.affiliation: From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.
authors.forename: Werner H
authors.initials: WH
authors.lastname: Mess
authors.affiliation: From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.
authors.forename: Ruud W
authors.initials: RW
authors.lastname: Keunen
authors.affiliation: From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.
authors.forename: Gisela M
authors.initials: GM
authors.lastname: Terwindt
authors.affiliation: From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.affiliation: From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.affiliation: From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Kruit
authors.affiliation: From the Department of Neurology (H.K., R.W.K.), Haga Hospital, The Hague; Departments of Neurology (H.K., G.M.T., M.D.F.) and Radiology (I.H.P.-M., M.A.v.B., M.C.K.), Leiden University Medical Center; Clinical Neurophysiology (W.H.M.), Maastricht University Medical Center, Netherlands; and Laboratory of Epidemiology and Population Sciences (L.J.L.), National Institute on Aging, Bethesda, MD.
authors.forename: Michel D
authors.initials: MD
authors.lastname: Ferrari
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods
chemical_list: D003287:Contrast Media