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Left- vs right-sided migraine: a scoping review

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Abstract

Background

Migraine is a historically unilateral head pain condition, the cause of which is not currently known. A growing body of literature suggests individuals who experience migraine with left-sided headache (“left-sided migraine”) may be distinguished from those who experience migraine with right-sided headache (“right-sided migraine”).

Objective

In this scoping review, we explore migraine unilaterality by summarizing what is currently known about left- and right-sided migraine.

Methods

Two senior medical librarians worked with the lead authors to construct and refine a set of search terms to identify studies of subjects with left- or right-sided migraine published between 1988, which is the year of publication of the first edition of the International Classification of Headache Disorders (ICHD), and December 8, 2021 (the date the searches were conducted). The following databases were searched: Medline, Embase, PsycINFO, PubMed, Cochrane Library, and Web of Science. Abstracts were loaded into Covidence review software, deduplicated, then screened by two authors to determine study eligibility. Eligible studies were those involving subjects diagnosed with migraine (according to ICHD criteria) in which the authors either: a) compared left- to right-sided migraine; or b) described (with analysis) a characteristic that differentiated the two. Data were extracted by the lead author, including ICHD version, the definition of unilateral migraine used by the authors, sample size, whether the findings were collected during or between attacks, and their key findings. The key findings were grouped into the following themes: handedness, symptoms, psychiatric assessments, cognitive testing, autonomic function, and imaging.

Results

After deduplication, the search yielded 5428 abstracts for screening. Of these, 179 met eligibility criteria and underwent full text review. 26 articles were included in the final analysis. All of the studies were observational. One study was performed during attack, nineteen between attacks, and six both during and between attacks. Left- and right-sided migraine were found to differ across multiple domains. In several cases, reciprocal findings were reported in left- and right-migraine. For example, both left- and right-sided migraine were associated with ipsilateral handedness, tinnitus, onset of first Parkinson’s symptoms, changes in blood flow across the face, white matter hyperintensities on MRI, activation of the dorsal pons, hippocampal sclerosis, and thalamic NAA/Cho and NAA/Cr concentrations. In other cases, however, the findings were specific to one migraine laterality. For example, left-sided migraine was associated with worse quality of life, anxiety, bipolar disorder, PTSD, lower sympathetic activity, and higher parasympathetic activity. Whereas right-sided migraine was associated with poorer performance on multiple cognitive tests, a greater degree of anisocoria, changes in skin temperature, higher diastolic blood pressure, changes in blood flow through the middle cerebral and basilar arteries, and changes on EEG.

Conclusion

Left- and right-sided migraine differed across a wide range of domains, raising the possibility that the pathophysiology of left- and right-migraine may not be identical.

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Abbreviations

ICHD:

International Classification of Headache Disorders

PTSD:

Posttraumatic stress disorder

PET:

Positron emission tomography

MRI:

Magnetic resonance imaging

TCD:

Transcranial Doppler ultrasound

EEG:

Electroencephalogram

TAC:

Trigeminal autonomic cephalalgia

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Authors and Affiliations

  1. Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, USA

    Adam S. Sprouse Blum

  2. Department of Neurological Sciences, University of California San Diego, San Diego, CA, USA

    Nina Y. Riggins

  3. Dana Medical Library, University of Vermont, Burlington, VT, USA

    Denise P. Hersey & Gary S. Atwood

  4. Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA

    Benjamin Littenberg

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Correspondence to Adam S. Sprouse Blum.

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Appendix A: PubMed and Ovid/Medline search strategies

Appendix A: PubMed and Ovid/Medline search strategies

PubMed

(("migrain*"[All Fields] AND ("unilateral"[All Fields] OR "unilaterally"[All Fields] OR "unilaterals"[All Fields] OR ("ipsilateral"[All Fields] OR "ipsilaterality"[All Fields] OR "ipsilaterally"[All Fields]) OR "one side*"[All Fields] OR "laterali*"[All Fields] OR "left side*"[All Fields] OR "right side*"[All Fields] OR "right hemispher*"[All Fields] OR "left hemispher*"[All Fields] OR "hemicranial"[All Fields])) NOT ("Animals"[MeSH Terms] NOT "medline"[Filter].

Ovid/Medline

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions(R) < 1946 to December 07, 2021 > 

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Blum, A.S.S., Riggins, N.Y., Hersey, D.P. et al. Left- vs right-sided migraine: a scoping review. J Neurol 270, 2938–2949 (2023). https://doi.org/10.1007/s00415-023-11609-1

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