Interatrial septal defect closure for prevention of cerebrovascular accidents: impact on recurrence and frequency of migraine headaches.

Background: Recent data suggest that percutaneous closure of interatrial septal defect (IASD) is associated with a reduction in the intensity, frequency and duration of migraine headaches. In this study we review our own data to determine if we can reproduce the relationship between IASD closure in patients with a history of a central nervous system event (stroke or a transient ischemic attack [TIA]) and migraine headaches (HA).

Methods: Fifty-eight consecutive patients with a history of unexplainable stroke or TIA with the exception of the presence of an IASD were included in this retrospective study. Multiple variables were collected including age, gender, history of smoking, hypertension, diabetes, hypercholesterolemia, ejection fraction, anticoagulant use pre- and postprocedure, shunt grade across the IASD pre- and postprocedure, defect size and right-sided filling pressures. All patients with a history of migraine HA answered the Migraine Disability Assessment Test (MIDAS), a standardized migraine questionnaire. Descriptive analysis was performed on all variables and compared among migraine and nonmigraine HA patients. Pre and post closure intensity and frequency of migraine HA were compared.

Results: Of 58 patients, 14 (24.14%) had migraine HAs prior to percutaneous closure. There were no significant differences among the migraine and nonmigraine HA groups except that the migraine HA sufferers were younger (p = 0.016). One patient with migraine HA died on follow up from complications of cardiomyopathy. Only 5 (38.5%) of 13 patients reported still having migraine HA post closure of IASD. The frequency (41.6 +/- 36.4 vs. 9.3 +/- 24.8; p = 0.005) and intensity (8.0 +/- 1.9 vs. 2.1 +/- 3.2; p = 0.001) of the migraine HAs were markedly reduced post closure at 759 +/- 545.6 days (range 89 to 1,433 days). There was no relationship between the shunt grade and the frequency or intensity of migraine HA.

Conclusion: We conclude that IASD closure in patients with history of migraine HA and stroke or TIA have a marked improvement in the frequency and intensity of their HA. Migraine HA resolved in 61.54% patients post closure. Larger randomized studies are needed to confirm these findings, which could have significant implications for sufferers of migraine HA.