Imperial College London

Professor Claire Shovlin

Faculty of MedicineNational Heart & Lung Institute

Professor of Practice (Clinical and Molecular Medicine)
 
 
 
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Contact

 

c.shovlin Website

 
 
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Location

 

534Block L Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Shovlin:2016:10.1111/head.12963,
author = {Shovlin, CL and Patel, T and Elphick, A and Jackson, JE},
doi = {10.1111/head.12963},
journal = {Headache},
pages = {1659--1663},
title = {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},
url = {http://dx.doi.org/10.1111/head.12963},
volume = {56},
year = {2016}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - 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 hemorrhagic telangiectasia (HHT), especially those with pulmonary AVMs that provide right-to-left shunts. In our clinical practice, patients occasionally reported acute precipitation of migraine 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 resonance 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 migraines (18/114 [15.7%]) compared to those undertaken without contrast medium (p<0.01), or after simple blood tests (p<0.05). Additionally, migraine exacerbation 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 e
AU - Shovlin,CL
AU - Patel,T
AU - Elphick,A
AU - Jackson,JE
DO - 10.1111/head.12963
EP - 1663
PY - 2016///
SN - 0017-8748
SP - 1659
TI - 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
T2 - Headache
UR - http://dx.doi.org/10.1111/head.12963
UR - http://hdl.handle.net/10044/1/33679
VL - 56
ER -