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Right-to-left shunt might have a relationship with migraine. The transition of vasoactive substances or microemboli seems to be the most assumed link between migraine and a right-to-left shunt.1 This hypothesis is enforced by the observation that percutaneous closure of patent foramen ovale is associated with a significant decrease in prevalence or severity of migraine attacks.2 In addition, other studies focused on haemoglobin levels and showed a positive relationship between frequency of migraine attacks and rising haemoglobin levels.3 Finally, the endothelium and its interaction with the surrounding tissue and blood compounds seem to play an important role in the current trigeminovascular theory of the pathogenesis of migraine,4 and new insights on the connection between endothelial genes and migraine are emerging.
We investigated the prevalence of migraine in patients with congenital heart disease with or without an obligate right-to-left shunt. All patients >16 years with an obligate right-to-left shunt, without …
Competing interests: None declared.