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 controls. Conclusion: Electrocardiographic alterations are observed in migraine patients compared to controls, especially during migraine attacks.