ROLE OF TRANSCRANIAL DOPPLER IN DETECTING RIGHT TO LEFT CIRCULATORY SHUNTS IN MIGRAINE HEADACHE PATIENTS.

Background: Migraine is a common disabling primary headache with an estimated prevalence of 13% of the general population. Right to left circulatory shunts, mostly patent foramen ovale, and migraine especially migraine with aura do exist. There is a debate whether this is a mere coincidence or a causal relationship. Objective: We aimed to evaluate the relationship between right to left circulatory shunt and migraine using transcranialdoppler. Methods: Using ultrasound studies (transthoracic echocardiography, transesophageal echocardiography, and transcranial color-coded duplex of middle cerebral artery) for detection of circulatory shunts in migraine patients either migraine with or without aura. Results: there is statistically significant presence of right to left circulatory shunts in the group of migraine with aura, in which 46.7% of the group showed latent shunts and were detected by transcranialdoppler (p value = 0.006). While only 13.3% of the common migraine group had right to left circulatory shunt (p value =0.54). Conclusion: Right to left circulatory shunts detected by TCD is a significant finding in migraine with aura. They are mostly latent shunts that are not present under basal conditions. They don?t cause hemodynamic abnormality in resting conditions. TCD is a good ultrasound diagnostic tool for detecting right to left circulatory shunts.