Relationship between migraine and cardiac and pulmonary right-to-left shunts
Relationship between migraine and cardiac and pulmonary right-to-left shunts
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DOI：
10.1042/cs20000231
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发表时间：
2001-02-01
期刊：
影响因子：
6
通讯作者：
Nightingale, S
中科院分区：
文献类型：
--
作者：
Wilmshurst, P;Nightingale, S
两项研究报告了先兆偏头痛与右-左分流之间的关系。从右到左分流也与某些形式的减压疾病有关。在对患有减压病的潜水员进行研究时，我们的印象是，大分流的潜水员在日常生活和潜水后经常有先兆偏头痛的病史。因此，我们定期询问所有潜水员偏头痛的症状。本文回顾了最近200例减压疾病调查患者的医疗记录，以确定右至左分流与潜水后偏头痛先兆以及与潜水无关的日常生活偏头痛之间的关系。日常生活中与潜水无关的先兆偏头痛在休息时存在较大分流的个体（38 / 80,47.5%）中发生的频率明显高于那些有较小分流或仅在Valsalva操作后出现的个体（40 / 4,10%）或没有分流的个体（80 / 1,13.8%）（P < 0.001）。偏瘫性偏头痛发生在10名潜水员中，他们每个人在休息时都有分流；在这些病例中，有8例分流管很大。无先兆偏头痛的患病率在所有组中相似。潜水后偏头痛先兆在休息时存在较大分流器的个体中（80人中有21人，26.3%）明显高于那些有较小分流器或仅在Valsalva操作后出现的个体（40人中有5人，12.5%）或没有分流器的个体（80人中有5人，12.5%）；1.3%) （p < 0.001）。因此，右至左分流较大的个体在与潜水无关的日常生活中有先兆偏头痛的患病率增加，但只有在潜水释放静脉泡时，他们在潜水后偏头痛先兆的发生率也增加。这些数据表明，在某些个体中，从右到左分流可能在先兆偏头痛的病因学中起作用。观察结果表明，矛盾气体栓塞可能导致先兆偏头痛。
A relationship between migraine with aura and the presence of right-re-left shunts has been reported in two studies. Right-to-left shunts are also associated with some forms of decompression illness. While conducting research in divers with decompression illness, it was our impression that divers with a large shunt often had a history of migraine with aura in everyday life and after dives. Therefore we routinely asked all divers about migraine symptoms. The medical records of the last 200 individuals referred for investigation of decompression illness were reviewed to determine the association between right-to-left shunts and migraine aura after diving, and migraine in daily life unconnected with diving. Migraine with aura in daily life unconnected with diving occurred significantly more frequently in individuals who had a large shunt which was present at rest (38 of 80; 47.5%) compared with those who had a shunt which was smaller or only seen after a Valsalva manoeuvre (four of 40; 10%) or those with no shunt (I I of 80; 13.8%) (P < 0.001). Hemiplegic migraine occurred in 10 divers, each of whom had a shunt that was present at rest; in eight of these cases the shunt was large. The prevalence of migraine without aura was similar in all groups. Post-dive migraine aura was significantly more frequent in individuals who had a large shunt present at rest (21 of 80; 26.3%) compared with those who had a shunt that was smaller or only seen after a Valsalva manoeuvre (five of 40; 12.5%) or no shunt tone of 80; 1.3%) (P < 0.001). Thus individuals with a large right-to-left shunt have an increased prevalence of migraine with aura in daily life unconnected with diving, acid they also have an increased incidence of migraine aura after dives, but only when the dives liberate venous bubbles. These data suggest the possibility that, in some individuals, right-to-left shunts have a role in the aetiology of migraine with aura. The observations suggest that paradoxical gas embolism may precipitate migraine with aura.