Evaluation of ventricular repolarization parameters during migraine attacks Mustafa Öztürk, M.D. a, ⁎,Oğuzhan Ekrem Turan, M.D. b , Kayıhan Karaman, M.D. c , Nuray Bilge, M.D. d , Gökhan Ceyhun, M.D. a , Ugur Aksu, M.D. a , Emrah Aksakal, M.D. a , Oktay Gulcu, M.D. a , Kamuran Kalkan, M.D. a , Selami Demirelli, M.D. a a Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey b Department of Cardiology, Aydın Atatürk State Hospital, Aydın, Turkey c Department of Cardiology, Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey d Department of Neurology, Atatürk University, Faculty of Medicine, Erzurum, Turkey abstract article info Available online xxxx Aims: Migraine is a chronic neurovascular disorder characterized by intermittent episodes of severe headache. Abnormalities in the autonomic nervous system (sympathetic and parasympathetic nervous systems) have been detected during migraine-free periods in patients with migraine. In these patients, disrupted autonomic in- nervations of the heart and coronary arteries may lead to electrocardiographic changes during a migraine attack. T-wave peak-to-end interval (Tp-e interval) and Tp-e/QT ratio are relatively new markers of ventricular arrhythmogenesis and repolarization heterogeneity. In the present observational study, we investigated the changes in ventricular repolarization during migraine attacks and attack-free periods by performing 12‑lead elec- trocardiography (ECG). Methods: This study included 63 patients (54 [86%] women; mean age: 33.3 ± 9.9 years) with migraine. The QT and corrected QT (QTc) intervals, Tp-e interval, and Tp-e/QT ratio of the patients during migraine attacks and attack-free periods were measured by performing 12‑lead ECG. Results: The QT and QTc intervals, Tp-e interval, and Tp-e/QT ratio were higher during migraine attacks than dur- ing attack-free periods (P b 0.001 for all). Conclusion: These results indicate that migraine attacks are associated with an increase in ventricular repolariza- tion parameters compared with attack-free periods possibly because of the dysregulation of the autonomic ner- vous system. © 2018 Elsevier Inc. All rights reserved. Keywords: Migraine Ventricular repolarization Autonomic nervous system Introduction Migraine is a neurological disorder characterized by recurrent epi- sodes of severe headache that affect various parts of the body, including the circulatory tract, gastrointestinal tract, and autonomic nervous sys- tem (ANS) [1].ANS dysregulation is suggested to be involved in the pathophysiology of migraine because autonomic symptoms such as nausea, vomiting, headache, and photophobia are common during acute migraine attacks. The symptoms associated with ANS dysregula- tion may be caused by an imbalance between the sympathetic and para- sympathetic nervous systems [2] that may induce some changes in ventricular repolarization during migraine attacks in patients with mi- graine [3].Some studies have reported prolonged PR and corrected QT (QTc) intervals during acute migraine attacks [4]. Recent studies have defined some electrocardiographic parameters for assessing the ele- vated risk of ventricular arrhythmias in patients with acute migraine; however, it is unclear as to which of these parameters are suitable for these patients. T-wave is one of the most important components of ventricular re- polarization on an electrocardiogram. Increased transmural dispersion of ventricular repolarization in the normal heart is associated with car- diac arrhythmias. Recent studies have reported that some ventricular repolarization markers, such as QT and QTc intervals, T-wave peak-to- end (Tp-e) interval, and Tp-e/QT ratio, are useful for predicting life- threatening cardiac arrhythmias in patients with various clinical disor- ders but without a structural heart disease [5]. Some studies have also reported that increased Tp-e interval and Tp-e/QTc ratio are associated Journal of Electrocardiology 53 (2019) 66–70 ⁎ Corresponding author. E-mail address: mozturk81@yahoo.com (M. Öztürk). https://doi.org/10.1016/j.jelectrocard.2018.12.014 0022-0736/© 2018 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Electrocardiology journal homepage: www.jecgonline.com