Is a predominant left-to-right shunt associated with migraine?: A prospective atrial septal defect closure study.
BACKGROUND
A right-to-left shunt, as seen in patients with a patent foramen ovale, seems to be associated with migraine. An atrial septal defect (ASD), however, is characterized by a predominant left-to-right shunt (LRS). We prospectively evaluated the effect of percutaneous ASD closure on migraine


METHODS
All 70 consecutive patients (>16 years) who underwent a percutaneous ASD closure between November 2003 and December 2005 in one of the two participating centers were included in the study. On the basis of standardized headache questionnaire, two independent neurologists diagnosed migraine with or without aura (MA+ and MA-, respectively) according to the International Headache Society criteria, before, 6 and 12 months after closure.


RESULTS
Sixty-eight patients (97%; mean age 47.3 + or - 16.4 years; 22% men) agreed to participate in the study and completed the questionnaire. Before ASD closure, the overall prevalence of migraine was 34%, MA+ 22% and MA- 12%. At 6 months follow-up, the headache questionnaire was completed by 63 patients (93%) and the prevalence of overall migraine decreased to 19%, MA+ to 8% and MA- to 11% (Mc Nemar test, P = 0.08, P = 0.07, and P = 1.0, respectively). At 12 months, the prevalence of migraine decreased further to 12%, MA+ to 5% and MA- to 7% (McNemar test, P = 0.003, P = 0.04, and P = 0.29 versus at inclusion, respectively) based on a completed headache questionnaire of 57 patients (84%).


CONCLUSIONS
We found a high prevalence of migraine in patients with an ASD, and observed prospectively a reduction in the occurrence of migraine, especially migraine with aura, 1 year after percutaneous closure.
Luermans
Justin G L M
JG
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Post
Martijn C
MC
Temmerman
Frederik
F
Thijs
Vincent
V
Schonewille
Wouter J
WJ
Plokker
H W Thijs
HW
Ten Berg
Jurriën M
JM
Suttorp
Maarten J
MJ
Budts
Werner I H L
WI
D000328:Adult; D001530:Belgium; D006328:Cardiac Catheterization / Q000295:instrumentation*; D015150:Echocardiography, Doppler; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D020326:Migraine without Aura / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D055989:Septal Occluder Device; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome