Injections of intravenous contrast for computerized tomography scans precipitate migraines in hereditary hemorrhagic telangiectasia subjects at risk of paradoxical emboli: implications for right-to-left shunt risks
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Author(s)
Shovlin, CL
Patel, T
Elphick, A
Jackson, JE
Type
Journal Article
Abstract
OBJECTIVE:
To evaluate if injection of intravenous particles may provoke migraines in subjects with right-to-left shunts due to pulmonary
arteriovenous
malformations (AVMs).
BACKGROUND:
Migraine headaches commonly affect people with hereditary hemo
rrhagic telangiectasia (HHT), es
pecially those with pulmonary
AVMs that provide right-to-left
shunts. In our clinical practice, patients occas
ionally reported acute precipitation of migrain
e headaches following injection
of technetium-labelled albumin macroaggregates for nuclear medicine scans.
METHODS:
Self-reported migraine features and exacerbations were examined in HHT subjects with and without pulmonary AVMs, for a series
of
noninvasive and invasive investigations, using an unbiased online survey
.
RESULTS:
166 subjects were classified as having both HHT and migraines.
HHT subjects with migraines were more likely to have pulmonary
AVMs
(p<0.0001). HHT subjects with pulmonary AVMs were more likely to report photophobia (p=0.010); ‘flashes of light’ (p=0.011), or
transient visual loss
(p=0.040). Pulse oximetry, x-rays, ultrasound and computerized tomography (CT) scans without intravenous contrast medium rarely
, if ever, provoked
migraines, but unenhanced magnetic resonan
ce imaging (MRI) was reported to exacerbate
migraines by 14/124 (11.2%) subjects. 114
had both enhanced and
unenhanced CT examinations: studies with contrast media were more commonly reported to start (9/114 [7.8%]), and/or worsen migr
aines (18/114 [15.7%])
compared to those undertaken without contrast medium (p<0.01), or after simple blood tests (p<0.05). Additionally, migraine exa
cerbation was reported by
9/90 (10%) after contrast echocardiography, 2/44 (4.5%) after nuclear medicine scans, and 10/154 (6.5%) after blood tests.
CONCLUSIONS:
HHT subjects frequently report migraine exacerbation following blood tests, contrast echocardiograms, MRI imaging, and CT stu
dies
performed with intravenous contrast medium. Since air emboli are recognised to complicate intravenous injections, particularly
following pressurised pump
injections of CT scan contrast, future studies should re-evaluate whether particulate emboli provoke migraines.
To evaluate if injection of intravenous particles may provoke migraines in subjects with right-to-left shunts due to pulmonary
arteriovenous
malformations (AVMs).
BACKGROUND:
Migraine headaches commonly affect people with hereditary hemo
rrhagic telangiectasia (HHT), es
pecially those with pulmonary
AVMs that provide right-to-left
shunts. In our clinical practice, patients occas
ionally reported acute precipitation of migrain
e headaches following injection
of technetium-labelled albumin macroaggregates for nuclear medicine scans.
METHODS:
Self-reported migraine features and exacerbations were examined in HHT subjects with and without pulmonary AVMs, for a series
of
noninvasive and invasive investigations, using an unbiased online survey
.
RESULTS:
166 subjects were classified as having both HHT and migraines.
HHT subjects with migraines were more likely to have pulmonary
AVMs
(p<0.0001). HHT subjects with pulmonary AVMs were more likely to report photophobia (p=0.010); ‘flashes of light’ (p=0.011), or
transient visual loss
(p=0.040). Pulse oximetry, x-rays, ultrasound and computerized tomography (CT) scans without intravenous contrast medium rarely
, if ever, provoked
migraines, but unenhanced magnetic resonan
ce imaging (MRI) was reported to exacerbate
migraines by 14/124 (11.2%) subjects. 114
had both enhanced and
unenhanced CT examinations: studies with contrast media were more commonly reported to start (9/114 [7.8%]), and/or worsen migr
aines (18/114 [15.7%])
compared to those undertaken without contrast medium (p<0.01), or after simple blood tests (p<0.05). Additionally, migraine exa
cerbation was reported by
9/90 (10%) after contrast echocardiography, 2/44 (4.5%) after nuclear medicine scans, and 10/154 (6.5%) after blood tests.
CONCLUSIONS:
HHT subjects frequently report migraine exacerbation following blood tests, contrast echocardiograms, MRI imaging, and CT stu
dies
performed with intravenous contrast medium. Since air emboli are recognised to complicate intravenous injections, particularly
following pressurised pump
injections of CT scan contrast, future studies should re-evaluate whether particulate emboli provoke migraines.
Date Issued
2016-10-11
Date Acceptance
2016-06-07
Citation
Headache, 2016, 56 (10), pp.1659-1663
ISSN
0017-8748
Publisher
Wiley
Start Page
1659
End Page
1663
Journal / Book Title
Headache
Volume
56
Issue
10
Copyright Statement
© 2016 The Authors Headache published by Wiley Periodicals, Inc. on behalf of American Headache Society
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Sponsor
Imperial College Trust
Grant Number
N/A
Subjects
Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences & Neurology
hereditary hemorrhagic telangiectasia (HHT)
pulmonary arteriovenous malformations (PAVMs)
magnetic resonance imaging (MRI)
computerized tomography (CT)
right-to-left shunt
contrast injection
Neurology & Neurosurgery
1103 Clinical Sciences
Publication Status
Published