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 -