title: Calcitonin gene-related peptide and size of the atrial septal defect in new-onset migraine after transcatheter closure: results of a preliminary study.
abstract: BACKGROUND
  New-onset migraine headache attacks (MHAs) can occur after atrial septal device implantation in patients without previous migraine. Plasma calcitonin gene-related peptide (CGRP), which plays a crucial role in migraine pathophysiology, has shown to be released from specific cardiac tissues.
  
  
  RESULTS
  We prospectively collected patients before and after closure and measured plasma CGRP levels using enzyme-linked immunosorbent assay. Forty atrial septal defect (ASD) patients who had no migraine previously were enrolled. Four (23.5%) of the 17 consecutive patients whose CGRP levels were checked before ASD closure had new-onset MHAs. The patients with MHAs had bigger ASD size (20 ± 0.9 vs 16 ± 1 mm, P = .009) and lower CGRP levels before closure (21.1 ± 3.9 vs 90.1 ± 27.1 pg/mL, P = .042) than those without. Among the 5 patients with blood samplings both during and between attacks, a paired comparison revealed a significantly increased level during attack (257.2 ± 45.5 vs 45.6 ± 25.5 pg/mL, P = .03).
  
  
  CONCLUSIONS
  Bigger ASD size and lower plasma CGRP levels before closure can be a potential predictor of new-onset MHAs. Furthermore, a significant increase of CGRP levels during migraine attack implies that the occurrences of new-onset MHAs after ASD closure correlate with the release of CGRP. This suggests CGRP sensitization from a lower baseline may be involved in the occurrence of new-onset MHAs after ASD closure.
authors.affiliation: Departments of Pediatrics, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan.
authors.forename: Shu-Hao
authors.initials: SH
authors.lastname: Wei
authors.forename: Pi-Chuan
authors.initials: PC
authors.lastname: Fan
authors.forename: Ping-Hung
authors.initials: PH
authors.lastname: Kuo
authors.forename: Lih-Chu
authors.initials: LC
authors.lastname: Chiou
authors.forename: Jou-Kou
authors.initials: JK
authors.lastname: Wang
mesh_terms: D000328:Adult; D015740:Calcitonin Gene-Related Peptide / Q000097:blood*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000453:epidemiology / Q000209:etiology*
chemical_list: D015740:Calcitonin Gene-Related Peptide