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The Role of Cardiac and Pulmonary Pathology in Migraine: A Hypothesis
Author(s) -
Wilmshurst Peter,
Nightingale Simon
Publication year - 2006
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/j.1526-4610.2006.00374.x
Subject(s) - patent foramen ovale , migraine , medicine , decompression illness , cardiology , shunt (medical) , etiology , lung , right to left shunt , anesthesia , decompression sickness , decompression , surgery
From observation of recent data linking migraine with right‐to‐left shunts and by analogy with the etiologies of decompression illness, we postulate that cardiac and pulmonary pathology can have an important effect on the cranial final common pathway that generates attacks of migraine. One possible mechanism is associated with a significant right‐to‐left shunt, which is usually through a persistent foramen ovale, but is sometime through a pulmonary shunt. This allows a venous agent, possibly 5‐hydroxytryptamine, to bypass the lung filter. Migraine can occur when there is no shunt if similar agents are liberated in the left heart beyond the lung filter, possibly by platelet activation. Migraine could also occur if the venous agents are produced in such large amounts that they overwhelm the pulmonary filter or are unaffected by passage through the lungs. In some individuals migraine may be unrelated to blood‐borne triggers.