This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (78) Citing Articles via Google Scholar Google Scholar Articles by Azarbal, B. Articles by Gaster, R. Search for Related Content PubMed PubMed Citation Articles by Azarbal, B. Articles by Gaster, R.

CLINICAL RESEARCH: MINI-FOCUS: TRANSCATHETER CLOSURE OF ASD AND PFO

Association of interatrial shunts and migraine headaches

Impact of transcatheter closure

Department of Medicine (Division of Cardiology), University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California

Manuscript received June 10, 2004; revised manuscript received September 15, 2004, accepted September 28, 2004.

^* Reprint requests and correspondence: Dr. Jonathan Tobis, Professor of Medicine, Department of Internal Medicine (Division of Cardiology), 47-123 Center for Health Sciences, 650 Charles E. Young Drive South, Los Angeles, California 90095 (Email: jtobis{at}mednet.ucla.edu).

OBJECTIVES: To examine the relationship between patent foramen ovale (PFO) or atrial septal defect (ASD) with the incidence of migraine headache (MHA) and assess whether closure of the interatrial shunt in patients with MHA would result in improvement of MHA.

BACKGROUND: Migraine headache is present in 12% of adults and has been associated with interatrial communications. This study examined the relationship between PFO or ASD with the incidence of MHA and assessed whether closure of the interatrial shunt in patients with MHA would result in improvement of MHA.

METHODS: A sample of 89 (66 PFO/23 ASD) adult patients underwent transcatheter closure of an interatrial communication using the CardioSEAL (n = 22), Amplatzer PFO (n = 43), or the Amplatzer ASD (n = 24) device.

RESULTS: Before the procedure, MHA was present in 42% of patients (45% of patients with PFO and 30% of patients with ASD). At three months after the procedure, MHA disappeared completely in 75% of patients with MHA and aura and in 31% of patients with MHA without aura. Of the remaining patients, 40% had significant improvement (2 grades by the Migraine Disability Assessment Questionnaire) of MHA.

CONCLUSIONS: Transcatheter closure of PFO or ASD results in complete resolution of MHA in 60% of patients (75% of patients with migraine and aura) and improvement in symptoms in 40% of the remaining patients. Interatrial communications may play a role in the etiology of MHA either through paradoxic embolism or humoral factors that escape degradation in bypassing the pulmonary circulation. A randomized trial is needed to determine whether transcatheter closure of interatrial shunts is an effective treatment for MHA.

Abbreviations and Acronyms   ASD = atrial septal defect   MHA = migraine headache   MIDAS = Migraine Disability Assessment Questionnaire   PFO = patent foramen ovale   TEE = transesophageal echocardiography

This article has been cited by other articles:

				J. D. Carroll and E. P. Carroll Is patent foramen ovale closure indicated for migraine?: PFO Closure Is Not Indicated for Migraine: "Don't Shoot First, Ask Questions Later" Circ Cardiovasc Interv, October 1, 2009; 2(5): 475 - 481. [Full Text] [PDF]

				A.-R. Fathi, P. Eshtehardi, and B. Meier Patent foramen ovale and neurosurgery in sitting position: a systematic review Br. J. Anaesth., May 1, 2009; 102(5): 588 - 596. [Abstract] [Full Text] [PDF]

				C. Vigna, N. Marchese, V. Inchingolo, G. M. Giannatempo, M. A. Pacilli, P. Di Viesti, M. Impagliatelli, R. Natali, A. Russo, R. Fanelli, et al. Improvement of Migraine After Patent Foramen Ovale Percutaneous Closure in Patients With Subclinical Brain Lesions: A Case-Control Study J. Am. Coll. Cardiol. Intv., February 1, 2009; 2(2): 107 - 113. [Abstract] [Full Text] [PDF]

				A Wahl and B Meier Patent foramen ovale and ventricular septal defect closure Heart, January 1, 2009; 95(1): 70 - 82. [Abstract] [Full Text] [PDF]

				D Kenny, M Turner, and R Martin When to close a patent foramen ovale Arch. Dis. Child., March 1, 2008; 93(3): 255 - 259. [Abstract] [Full Text] [PDF]

				R. J. Sommer, Z. M. Hijazi, and J. F. Rhodes Jr Pathophysiology of Congenital Heart Disease in the Adult: Part I: Shunt Lesions Circulation, February 26, 2008; 117(8): 1090 - 1099. [Full Text] [PDF]

				M.T. Lonnebakken, G. Greve, E. Leirgul, and E. Gerdts Brain abscess caused by paradoxical embolization in Ebstein's anomaly Eur J Echocardiogr, January 1, 2008; 9(1): 105 - 106. [Abstract] [Full Text] [PDF]

				H. Hara, T. K. Jones, E. R. Ladich, R. Virmani, D. C. Auth, J. E. Eichinger, R. J. Sommer, R. A. Van Tassel, and R. S. Schwartz Patent Foramen Ovale Closure by Radiofrequency Thermal Coaptation: First Experience in the Porcine Model and Healing Mechanisms Over Time Circulation, August 7, 2007; 116(6): 648 - 653. [Abstract] [Full Text] [PDF]

				O. I.I. Soliman, M. L. Geleijnse, F. J. Meijboom, A. Nemes, O. Kamp, P. Nihoyannopoulos, N. Masani, S. B. Feinstein, and F. J. Ten Cate The use of contrast echocardiography for the detection of cardiac shunts Eur J Echocardiogr, June 1, 2007; 8(3): s2 - s12. [Abstract] [Full Text] [PDF]

				M. A. Samuels Update in Neurology Ann Intern Med, January 16, 2007; 146(2): 128 - 132. [Full Text] [PDF]

				S. Di Legge and F. Sallustio Migraine Relief After Patent Foramen Ovale Closure: Should Vascular Risk Factor Control Be Achieved First? Stroke, December 1, 2006; 37(12): 2876 - 2876. [Full Text] [PDF]

				B. Lapergue, C. Rosso, L. Hadrane, J. Labreuche, H. Abboud, E. Brochet, J. -M. Juliard, and P. Amarenco Frequency of migraine attacks following stroke starts to decrease before PFO closure. Neurology, September 26, 2006; 67(6): 1099 - 1100. [Full Text] [PDF]

				M. C. Post and W. Budts The Relationship Between Migraine and Right-to-Left Shunt: Fact or Fiction? Chest, September 1, 2006; 130(3): 896 - 901. [Abstract] [Full Text] [PDF]

				B. Wertman, B. Azarbal, M. Riedl, and J. Tobis Adverse Events Associated With Nickel Allergy in Patients Undergoing Percutaneous Atrial Septal Defect or Patent Foramen Ovale Closure J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1226 - 1227. [Full Text] [PDF]

				I. A. Russell, K. Rouine-Rapp, G. Stratmann, and W. C. Miller-Hance Congenital heart disease in the adult: a review with internet-accessible transesophageal echocardiographic images. Anesth. Analg., March 1, 2006; 102(3): 694 - 723. [Full Text] [PDF]

				G. P. Anzola, G. B. Frisoni, E. Morandi, F. Casilli, and E. Onorato Shunt-Associated Migraine Responds Favorably to Atrial Septal Repair: A Case-Control Study Stroke, February 1, 2006; 37(2): 430 - 434. [Abstract] [Full Text] [PDF]

				M. C. Post, V. Thijs, W. J. Schonewille, W. Budts, R. J. Snijder, H.W.M. Plokker, and C. J.J. Westermann Embolization of pulmonary arteriovenous malformations and decrease in prevalence of migraine Neurology, January 24, 2006; 66(2): 202 - 205. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas Highlights of the Year in JACC 2005 J. Am. Coll. Cardiol., January 3, 2006; 47(1): 184 - 202. [Full Text] [PDF]

				M. Schwerzmann, K. Nedeltchev, F. Lagger, H. P. Mattle, S. Windecker, B. Meier, and C. Seiler Prevalence and size of directly detected patent foramen ovale in migraine with aura Neurology, November 8, 2005; 65(9): 1415 - 1418. [Abstract] [Full Text] [PDF]

				H. Hara, R. Virmani, E. Ladich, S. Mackey-Bojack, J. Titus, M. Reisman, W. Gray, M. Nakamura, M. Mooney, A. Poulose, et al. Patent Foramen Ovale: Current Pathology, Pathophysiology, and Clinical Status J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1768 - 1776. [Abstract] [Full Text] [PDF]

				V. K. Gupta Patent Foramen Ovale/Atrial Septal Defect Closure and Migraine: Searching the Rationale for the Procedure J. Am. Coll. Cardiol., August 16, 2005; 46(4): 737 - 738. [Full Text] [PDF]

				J. Tobis and B. Azarbal Reply J. Am. Coll. Cardiol., August 16, 2005; 46(4): 738 - 739. [Full Text] [PDF]

				Transcatheter Closure of Patent Foramen Ovale for Migraine Prophylaxis Journal Watch Neurology, June 23, 2005; 2005(623): 2 - 2. [Full Text]

				T. P. Graham Jr The Year in Congenital Heart Disease J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1887 - 1899. [Full Text] [PDF]

				Interatrial-Closure Procedures Might Resolve Migraines Journal Watch Cardiology, April 8, 2005; 2005(408): 9 - 9. [Full Text]