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

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 χ² 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.