Migraine headaches following catheter ablation for atrial fibrillation.
BACKGROUND
Atrial septal defects (ASD), including patent foramen ovale, have been linked to an increased prevalence of migraine headaches in the general population. A similar association with migraine is speculated for iatrogenic ASD due to atrial septal puncture during catheter ablation for atrial fibrillation (AF).


METHODS
A total of 2,069 patients who underwent catheter ablation for AF at Mayo Clinic, Rochester, MN between January 2001 and December 2008 were scheduled for follow-up at least at 3 months and annually thereafter. Data were collected from the questionnaires patients answered at follow-up inquiring about presence and characteristics of any headaches following the procedure and further chart review. Definite migraine was diagnosed based on clinical features per the International Classification of Headache Disorder-II definition.


RESULTS
Twenty-two patients (1.1%) had a new-onset definite migraine, 12 (0.6%) had a new-onset probable migraine, ten (0.5%) with a previous history of migraine had worsened headaches, and four (0.2%) had headache due to an alternate identifiable cause; a total of 48 patients (2.3%) reported post-procedural headaches. Nineteen of 22 patients (86%) with definite migraine had complete resolution of symptoms at 1- to 2-year follow-up.


CONCLUSIONS
New-onset migraine is an uncommon and usually temporary side effect of catheter ablation for AF. The mechanism for post-procedure headache remains unclear.
Noheria
Amit
A
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, MN 55905, USA.
Roshan
John
J
Kapa
Suraj
S
Srivathsan
Komandoor
K
Packer
Douglas L
DL
Asirvatham
Samuel J
SJ
D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy / Q000209:etiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires