{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:44:11Z","timestamp":1783435451705,"version":"3.54.6"},"reference-count":71,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2014,1,23]],"date-time":"2014-01-23T00:00:00Z","timestamp":1390435200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To identify whether relationships exist between epistaxis and migraines in hereditary hemorrhagic telangiectasia (HHT), to potentially provide further preventative and therapeutic options for the debilitating nosebleeds that are often very difficult to manage in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Study participants were recruited from a UK specialist service, and online following advertisement by the HHT Foundation International. They completed a nonbiased questionnaire in which paired questions on nosebleeds and migraines were separated by at least 17 other questions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Migraines were defined as headaches with associated autonomic and\/or neurological features. The reported frequencies and precipitants of epistaxis and migraines were compared using numerical scales applied equally for each condition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 220 HHT\u2010affected respondents reported frequent nosebleeds, 153 (69.5%) used iron tablets, and 39 (17.7%) had received at least 10 blood transfusions. Migraines displaying typical features were reported by 51 (23.2%), and were more common with pulmonary or cerebral arteriovenous malformations. Thirty of 51 (58.8%) migraine sufferers reported that nosebleeds occurred at the same time as their migraines. More frequent migraines were reported by patients with more frequent nosebleeds (<jats:italic>r<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200915%, <jats:italic>P<\/jats:italic>\u2009=\u2009.007), or transfusions (<jats:italic>r<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200916.9%, <jats:italic>P<\/jats:italic>\u2009=\u2009.004). In menstrual, lifestyle, and dietary analyses, consistency was observed between factors having no effect, and those provoking both nosebleeds and migraines in multiple patients (premenses; activity; lack of sleep; stress; caffeine, cheese, alcohol, and chocolate).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We demonstrate an unexpected and provocative association between nosebleeds and migraines in HHT patients. Evaluation of whether antimigraine approaches limit HHT nosebleeds may be appropriate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4<jats:italic>Laryngoscope<\/jats:italic>, 124:1521\u20131528, 2014<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.24526","type":"journal-article","created":{"date-parts":[[2013,11,15]],"date-time":"2013-11-15T05:55:19Z","timestamp":1384494919000},"page":"1521-1528","source":"Crossref","is-referenced-by-count":27,"title":["Relationships between epistaxis, migraines, and triggers in hereditary hemorrhagic telangiectasia"],"prefix":"10.1002","volume":"124","author":[{"given":"Amy","family":"Elphick","sequence":"first","affiliation":[{"name":"Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare National Health Service Trust London United Kingdom"},{"name":"Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London United Kingdom"},{"name":"School of Life Sciences Imperial College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire L.","family":"Shovlin","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare National Health Service Trust London United Kingdom"},{"name":"Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,1,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2010.07.001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2796.1999.00398.x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/humu.10026"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2005.030833"},{"key":"e_1_2_7_6_1","first-page":"3487","article-title":"Real\u2010time imaging of de novo arteriovenous malformation in a mouse model of hereditary hemorrhagic telangiectasia","volume":"119","author":"Park S","year":"2009","journal-title":"J Clin Invest"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nm.2131"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/GIM.0b013e3182136d32"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199109000-00008"},{"key":"e_1_2_7_10_1","first-page":"40","article-title":"Natural history and control of epistaxis in a group of German patients with Rendu\u2010Osler\u2010Weber disease","volume":"43","author":"Folz BJ","year":"2005","journal-title":"Rhinology"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23893"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.1320320302"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2012.26.3809"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2009.069013"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0076516"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino09.138"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino10.090"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000154749.09303.e0"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2008.22.3145"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20065"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21415"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2011.07.012"},{"key":"e_1_2_7_23_1","first-page":"85","article-title":"The effect of N\u2010acetylcysteine on epistaxis and quality of life in patients with HHT: a pilot study","volume":"47","author":"Gussem E","year":"2009","journal-title":"Rhinology"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.2500\/105065899782102890"},{"key":"e_1_2_7_25_1","first-page":"S17","article-title":"Migraine prevalence. 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