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Pulmonary arteriovenous malformations associated with migraine with aura

Depts of ¹ Cardiology, ² Pulmonology, ³ Radiology, and ⁴ Neurology, St Antonius Hospital, Nieuwegein, The Netherlands. ⁵ Dept of Neurology, University Hospital Gasthuisberg, and ⁶ Vesalius Research Center, Leuven, Belgium.

CORRESPONDENCE: M. C. Post, Dept of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, The Netherlands. E-mail: m.post{at}antonius.net

Keywords: Hereditary haemorrhagic telangiectasia, migraine, shunt

Received: November 25, 2008
Accepted March 16, 2009

Migraine with aura (MA) is associated with cardiac right-to-left shunt. We prospectively studied the association between pulmonary arteriovenous malformations (PAVMs) and MA in hereditary haemorrhagic telangiectasia (HHT).

All 220 consecutive HHT patients who underwent high-resolution chest computed tomography for PAVM screening were included prospectively. Prior to screening, a structured validated headache questionnaire was completed by 196 patients (57% female; mean±sd age 44.6±15.2 yrs). Two neurologists diagnosed migraine according to the International Headache Society Criteria.

A PAVM was present in 70 (36%) patients. The prevalence of MA was 24% in the presence of a PAVM compared with 6% in the absence of a PAVM (OR 4.6, 95% CI 1.84–11.2; p = 0.001), and MA was an independent predictor for the presence of PAVM using multivariate analysis (OR 3.6, 95% CI 1.21–10.5; p = 0.02). A PAVM was present in 68% of the patients with MA compared with 32% in the non-migraine controls (OR 4.6, 95% CI 1.84–11.2; p = 0.001), and a PAVM was an independent predictor for MA using multivariate analysis (OR 3.0, 95% CI 1.00–9.20; p = 0.05).

In conclusion, PAVMs are associated with MA in HHT patients.