Evaluation of coronary microvascular function in patients with migraine

Migraine is a common neurovascular disorder characterized by attacks of severe headache, autonomic and neurological symptoms. Migraine can affect many systems in the body, yet its effects on cardiovascular system are unclear. The aim of the present study was to investigate the potential association of migraine with coronary microvascular dysfunction. Forty migraine patients and thirty five healthy volunteers were included to our clinical trial. By using transthorasic echocardiography, coronary flow was visualized in the middle or distal part of the left anterior descending artery. Coronary diastolic peak flow velocities were measured with pulse wave Doppler at baseline and after dipyridamole infusion (0.56 mg/kg/4 minutes). CFR≥2 was considered normal. 52 women (69,3%) and 23 men (30,7%) were included into our trial. Mean ages in migraine and control groups were similar (30,7±7,5; 33,7±7,5; p>0,05). Patients' sexes were similar in both groups. CFR was significantly lower in the migraine group than the control group (1,99±0,3; 2,90±0,5; p<0,05). Left ventricular ejection fractions were similar in both groups. Mitral annulus lateral and septal systolic velocities were lower in migraineurs than in the control group. The ratio of early mitral diastolic flow velocity to early mitral annular diastolic velocity (E/E' lateral and E/E' septal) which indicates the left ventricular filling pressure was higher in the migraine group than in the control group. In the light of these findings, impaired CFR in migraine patients is thought to be caused by the coronary microvascular dysfunction. Microvascular dysfunction is related to impaired endothelial vasodilatation which is associated with migraine, vasomotor dysfunction and increased systemic inflammatory factors. Decreased mitral annular systolic velocity can predict subclinical LV dysfunction in migraine patients. Also increased E/E' ratio in migraine patients can predict early diastolic dysfunction. Key Words: Migraine, Coronary flow reserve, Microvascular dysfunction