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J Am Coll Cardiol, 2005; 45:489-492, doi:10.1016/j.jacc.2004.09.075
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: MINI-FOCUS: TRANSCATHETER CLOSURE OF ASD AND PFO

Association of interatrial shunts and migraine headaches

Impact of transcatheter closure

Babak Azarbal, MD, Jonathan Tobis, MD*, William Suh, MD, Vicki Chan, BA, Catherine Dao, BA and Richard Gaster

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




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