Electrographic indices in migraine patients: A systematic review and meta-analysis

Background and aim Migraine patients can exhibit autonomic dysregulation, in turn leading to cardiac conduction and repolarization abnormalities. This systematic review and meta-analysis evaluated the electrocardiographic changes in migraineurs. Method PubMed and Embase databases were searched for human studies using the search terms ‘migraine’ and ‘electrocardiogram’ until 15th December 2018, identifying 108 and 131 studies. Results Thirteen studies involving 667 migraineurs and 208 normal subjects included (mean age=30.7, total male percentage=19.8%) were included. A longer mean QTc interval (standard mean difference=7.89, 95% confidence interval=[3.29, 12.49], p=0.0008) and higher frequency of QTc prolongation (risk ratio [RR]=6.23, [2.86–13.58], p <0.00001), but no difference in PR-interval (SMD=4.33, [−3.90–12.56], p =0.30) were observed during migraine attacks compared to pain-free periods. P-wave dispersion was higher in migraine patients compared to controls (mean difference=3.62, [1.03–6.21], p =0.006). RR-interval were statistically indistinguishable between migraine patients and controls (SMD=0.08, [−0.65–0.81], p =0.83), or between migraineurs with and without aura (SMD=−0.03, [−0.44–0.38], p =0.89). Deep breathing ratio was significantly lower in migraineurs compared to controls (SMD=−0.27, 95% CI=[−0.46, −0.08], p =0.006) but similar between migraineurs with and without aura (SMD=−0.04, [−0.27–0.19], p =0.74). No significant difference in Valsalva ratio is found between migraineurs and controls (SMD=0.10, [−0.32–0.53], p =0.63) or between migraineurs with and without aura (SMD=−0.17, [−0.40–0.06], p =0.14). Root mean square of successive differences (RMSSD) (SMD=−0.07, [−1.10–0.95], p =0.89) and standard deviation of NN intervals (SDNN) (SMD=−0.10, [−0.61–0.41], p =0.71) did not significantly differ between migraine patients and control. Conclusion Electrocardiographic alterations are observed in migraine patients compared to controls, especially during migraine attacks.