The Relation between Right‐to‐Left Shunt and Migraine: Focus on Pulmonary Arteriovenous Malformations

Review Article


WF Marco van Gent¹, HAM Michiel van Helden¹, J Johannes Mager² and C Martijn Post¹

Affiliations: Department of ¹Cardiology and ²Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands


ABSTRACT

Migraine is a common and disabling disorder. Pulmonary arteriovenous malformations (PAVMs) cause a right‐to‐left shunt (RLS). An increased prevalence of migraine, particularly migraine with aura (MA+), has been shown in patients with a RLS of both pulmonary and cardiac origin. The prevalence of PAVM in patients with hereditary hemorrhagic telangiectasia (HHT) is 15–45%. Therefore, the HHT population provides a unique opportunity to study the RLS–migraine hypothesis. Embolization of PAVMs might reduce the prevalence of migraine, and an association between PAVM in HHT patients and MA+ was shown recently in a prospective study. The current review focuses on the evidence of a real association between an intrapulmonary RLS and migraine, and summarizes the possible underlying pathogenesis.

Keywords: pulmonary arteriovenous malformations, right‐to‐left shunt, migraine, hereditary hemorrhagic telangiectasia, patent foramen ovale
Correspondence: M C Post, Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands. Tel: (31)‐30‐6099111; Fax: (31)‐30‐6092274; e‐mail: m.post@ antoniusziekenhuis.nl