Small- and moderate-size right-to-left shunts identified by saline contrast echocardiography are normal and unrelated to migraine headache

Timothy Woods, Leanne Harmann, Traci Purath, Suresh Ramamurthy, Sharath Subramanian, Scott Jackson, Sergey Tarima

Research output: Contribution to journalArticle

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Abstract

Background: We suspected, based on clinical experience, that the prevalence of both intracardiac and pulmonary arteriovenous malformations (PAVMs) is higher than previously reported in a healthy population when using modern ultrasound technology combined with a rigorous saline contrast echocardiogram (SCE) protocol. We hypothesized the prevalence of right-to-left shunts (RLSs) would be so high when using this sensitive technique that there would be no significant association of RLS with migraine headache. Methods: We recruited 104 healthy volunteers to undergo an SCE followed by completion of a migraine questionnaire. The SCEs were meticulously graded for shunt size and location based on left-sided heart contrast quantity and timing. The migraine headache questionnaire was graded by a neurologist blinded to SCE results. Results: One hundred four subjects underwent the study protocol. We found 71% of subjects exhibited evidence of RLS. Patent foramen ovale (PFO) was identified in 40 (38%), PAVM was identified in 29 (28%), and five subjects had evidence of both (5%). Based on questionnaires, 42 (40%) of the subjects had migraine headache (29% with aura). There was no significant association of migraine headache with PFO (OR, 0.59; 95% CI, 0.16-2.12; P = .54) or PAVM (OR, 0.8; 95% CI, 0.34-1.9; P = .67), although only 13 (13%) of the subjects had evidence of large RLS. Conclusions: When using modern ultrasound technology combined with a rigorous SCE technique, the majority of healthy subjects demonstrate some degree of RLS. PAVM in an otherwise healthy population is common. Small- and moderate-size RLSs do not appear to be significantly associated with migraine headache.

Original languageEnglish (US)
Pages (from-to)264-269
Number of pages6
JournalChest
Volume138
Issue number2
DOIs
StatePublished - Aug 1 2010
Externally publishedYes

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Migraine Disorders
Echocardiography
Arteriovenous Malformations
Patent Foramen Ovale
Lung
Healthy Volunteers
Technology
Population
Epilepsy
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Small- and moderate-size right-to-left shunts identified by saline contrast echocardiography are normal and unrelated to migraine headache. / Woods, Timothy; Harmann, Leanne; Purath, Traci; Ramamurthy, Suresh; Subramanian, Sharath; Jackson, Scott; Tarima, Sergey.

In: Chest, Vol. 138, No. 2, 01.08.2010, p. 264-269.

Research output: Contribution to journalArticle

Woods, Timothy ; Harmann, Leanne ; Purath, Traci ; Ramamurthy, Suresh ; Subramanian, Sharath ; Jackson, Scott ; Tarima, Sergey. / Small- and moderate-size right-to-left shunts identified by saline contrast echocardiography are normal and unrelated to migraine headache. In: Chest. 2010 ; Vol. 138, No. 2. pp. 264-269.
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AU - Jackson, Scott

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