The relationship between right to left shunt (RLS) and non-headache symptoms (NHS) in episodic migraine is unknown. This study aimed to investigate the incidence and classification of RLS in episodic migraineurs, calculate the occurrence rate of NHS, and analyze the associations between RLS and NHS. We consecutively recruited 204 episodic migraine patients. Contrast-enhanced transcranial doppler was adopted to screen RLS. Structured questionnaire via face-to-face survey was conducted to collect clinical data. A total of 172 episodic migraineurs were included in the final analysis, of which 20 cases were migraine with aura. The positive rate of RLS was 47.1%, of which 50 cases (29.0%) had small shunt (Grade 1) and 31 cases (18.1%) had mid-large shunt (Grade 2–4). The most common NHS was nausea (115 (66.9%)), followed by headache aggravation with physical activity (96 (55.8%)), dizziness (93 (54.1%)), vomiting (77 (44.8%)) and phonophobia (74 (43.0%)). Yawning was more common in Grade 2–4 group than Grade 0 group (p = 0.012), while no statistical differences among other groups. Grade 2–4 group had a higher rate of headache aggravation with physical activity than grade 0 group (p = 0.008). Binary logistic regression analysis showed that yawning at premonitory phase, headache aggravation with physical activity and cranial autonomic symptoms during attack are independent predictors of RLS. In conclusion, yawning and headache aggravation with physical activity are more common in migraine patients with RLS. Besides aura, particular NHS may also serve as indicators for screening RLS in episodic migraineurs.

发作性偏头痛中从右向左分流（RLS）与非头痛症状（NHS）之间的关系尚不清楚。本研究旨在调查发作性偏头痛患者中RLS的发生率和分类，计算NHS的发生率，并分析RLS与NHS之间的关联。我们连续招募了204名发作性偏头痛患者。采用对比增强的经颅多普勒筛查RLS。进行了面对面调查的结构化问卷，以收集临床数据。最终分析总共包括172个发作性偏头痛，其中20例为偏头痛先兆。RLS的阳性率为47.1％，其中50例（29.0％）为小分流（1级），31例（18.1％）为中大分流（2-4级）。最常见的NHS是恶心（115（66.9％）），其次是剧烈头痛，包括体力活动（96（55.8％）），头晕（93（54.1％）），呕吐（77（44.8％））和恐惧症（74（43.0％））。2至4级组的打呵欠比0级组更常见（p = 0.012），而其他组之间无统计学差异。2-4级组与体育活动相比，头痛和剧烈活动的发生率高于0级组（p = 0.008）。二进制逻辑回归分析表明，发作前打哈欠，发作时头痛加重体力活动和颅脑自主神经症状是RLS的独立预测因子。总之，偏头痛伴RLS的人经常出现打哈欠和头痛加重体力活动。除了先兆之外，特定的NHS还可作为筛选散发性偏头痛的RLS的指标。呕吐（77（44.8％））和恐惧症（74（43.0％））。2至4级组的打呵欠比0级组更常见（p = 0.012），而其他组之间无统计学差异。2-4级组与体育活动相比，头痛和剧烈活动的发生率高于0级组（p = 0.008）。二进制逻辑回归分析表明，发作前打哈欠，发作时头痛加重体力活动和颅脑自主神经症状是RLS的独立预测因子。总之，偏头痛伴RLS的人经常出现打哈欠和头痛加重体力活动。除了先兆之外，特定的NHS还可作为筛选散发性偏头痛的RLS的指标。呕吐（77（44.8％））和恐惧症（74（43.0％））。2至4级组的打呵欠比0级组更常见（p = 0.012），而其他组之间无统计学差异。2-4级组与体育活动相比，头痛和剧烈活动的发生率高于0级组（p = 0.008）。二进制逻辑回归分析表明，发作前打哈欠，发作时头痛加重体力活动和颅脑自主神经症状是RLS的独立预测因子。总之，偏头痛伴RLS的人经常出现打哈欠和头痛加重体力活动。除了先兆之外，特定的NHS还可作为筛选散发性偏头痛的RLS的指标。其他组之间无统计学差异。2-4级组与体育活动相比，头痛和剧烈活动的发生率高于0级组（p = 0.008）。二进制逻辑回归分析表明，发作前打哈欠，发作时头痛加重体力活动和颅脑自主神经症状是RLS的独立预测因子。总之，偏头痛伴RLS的人经常出现打哈欠和头痛加重体力活动。除了先兆之外，特定的NHS还可作为筛选散发性偏头痛的RLS的指标。其他组之间无统计学差异。2-4级组与体育活动相比，头痛和剧烈活动的发生率高于0级组（p = 0.008）。二进制逻辑回归分析表明，发作前打哈欠，发作时头痛加重体力活动和颅脑自主神经症状是RLS的独立预测因子。总之，偏头痛伴RLS的人经常出现打哈欠和头痛加重体力活动。除了先兆之外，特定的NHS还可作为筛选散发性偏头痛的RLS的指标。发作期间进行体育锻炼时头痛加重以及颅脑自主神经症状是RLS的独立预测因子。总之，偏头痛伴RLS的人经常出现打哈欠和头痛加重体力活动。除了先兆之外，特定的NHS还可作为筛选散发性偏头痛的RLS的指标。发作期间进行体育锻炼时头痛加重以及颅脑自主神经症状是RLS的独立预测因子。总之，偏头痛伴RLS的人经常出现打哈欠和头痛加重体力活动。除了先兆之外，特定的NHS还可作为筛选散发性偏头痛的RLS的指标。