Abstract 2639: PFO or PAVM Have No Association With Migraine Headache
Background: Previous saline contrast echo (SCE) studies reporting patent foramen ovale (PFO) prevalence used outdated analog M-mode or fundamental 2D imaging. No prospective SCE study has identified the prevalence of pulmonary arteriovenous malformation (PAVM) in an otherwise healthy population. Although reports suggest an association between migraine headache (MH) and PFO, few have investigated an association with PAVM.
Hypothesis: We hypothesize that when SCE is performed using digitally acquired harmonic imaging at high frame rates and slow playback, the prevalence of both PFO and PAVM in an otherwise healthy population is higher than previously suspected. We further hypothesize that both PFO and PAVM are associated with MH.
Methods: Healthy volunteers (n=104, ages 18 –55, 39 men) were recruited to undergo SCE using rigorous technique including multiple Valsalva and cough injections. Digital image loops were acquired at average frame rate of 60 Hz and reviewed in slow playback with ≥ 1 clear bubble in ≥ 2 digital frames defining the presence of shunt, and the three-beat rule used to differentiate PFO vs PAVM. Less than 10 bubbles defined a small shunt, and ≥ 20 left heart bubbles in a single frame determined a large shunt. Each volunteer then completed a 15 point migraine questionnaire that was graded by a neurologist blinded to SCE results.
Results: Of 104 volunteers, 32 (31%) had PAVM , 43 (41%) had PFO, and 5 (5%) had both. MH was present in 44 (42%) of volunteers based on questionnaire grading. There was no significant association of PFO or PAVM with MH, even when analysis was restricted to large size PFO.
Conclusions: A large percent of otherwise healthy people appear to suffer from MH. The prevalence of PFO is larger than previously suspected when current ultrasound technology and meticulous SCE technique is employed. Asymptomatic PAVM in otherwise healthy people are common. At least with small to moderate size PFO or PAVM, there is no significant association with MH.