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European Heart Journal Advance Access published online on March 3, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi170
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

The influence of percutaneous atrial septal defect closure on the occurrence of migraine

K. Mortelmans 1, M. Post 1, V. Thijs 2, L. Herroelen 2, and W. Budts 1*

1 Department of Cardiology, Internal Medicine, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
2 Department of Neurology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium

* To whom correspondence should be addressed.
W. Budts, E-mail: werner.budts{at}uz.kuleuven.ac.be


  Abstract

Aims Percutaneous patent foramen ovale closure seems to influence migraine. We wanted to observe the effect of percutaneous atrial septal defect (ASD) closure on migraine.

Methods and results All patients (>16 years of age) with a percutaneous ASD closure were selected from our database (n = 114). A questionnaire about headache before and after closure was sent. According to the criteria of the International Headache Society, two neurologists diagnosed migraine with and without aura (MA+ and MA-, respectively). McNemar paired {chi}2 and Wilcoxon signed rank tests were used where applicable. Seventy-five patients (66%, 59 females, mean age 51 ± 19 years) responded and were included in the study. An Amplatzer ASD occluder was used in all. Median follow-up time was 29 months (IQ1 and IQ3, 18 and 39 months, respectively). The prevalence of MA- and MA+ changed from 19 (14/75) and 11% (8/75), respectively, before closure to 12 (9/75) and 15% (11/75), respectively, after closure (P = 0.18 and P = 0.55, respectively, vs. before closure). In 12 patients who suffered from migraine before closure (n = 4 and 8, MA+ and MA-, respectively), migraine disappeared. In this subgroup, the frequency of migraine attacks decreased significantly (P = 0.01). New-onset migraine was noted in 10 patients (n = 7 and 3, MA+ and MA-, respectively).

Conclusion Percutaneous ASD closure was not related to a decrease in prevalence of migraine. In a subgroup, patients who suffered from typical migraine before ASD closure, the frequency of migraine attacks decreased significantly. The reason for the new-onset migraine remains unexplained. A larger study sample will be necessary to determine these findings.

Keywords: Migraine; Atrial septum defect; Transcatheter closure; Amplatzer device.
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