Risk of migraine in atrial septal defects carriers

Abstract

The association between atrial septal defect (ASD) and migraine has been reported by several authors. The majority of such reports, however, are series of cases. The power of this association is hampered by the lack of analytic studies.Objective: To determine the magnitude of the association between ASD and migraine.Method: Case-control study. We evaluated 101 patients submitted to transesophageal echocardiography (TEE) from January to December 2004. An interview was carried out prior to the TEE in order to establish the diagnosis of migraine, according to the International Headache Society criteria. The subjects were divided into two groups: cases (ASD carrier) and controls (without ASD). They were matched by sex, age and social class. The following variables were analyzed: 1. proportion of migraine in each group, 2. occurrence of aura, and 3. more than three crises per month in migraine carriers in each group. The proportion of events was compared and the differences of occurrence of migraine analyzed by the chi-square test. The odds ratio (OR) and the 95% confidence interval (CI) were calculated. It was considered significant the p value 0.05. Results:The mean age of the 101 subjects was 37.7 (SD=11.2); 83.2% were female; 48.3% had ASD and 61.9% (58 subjects) had migraine, 51% of which reported aura. After matching, the results between cases/controls were: number of patients (34/34), female gender (82.4%/82.4%); mean age in years 38.7 (SD 11.24) / 38.9 (SD 11.17); frequency of migraine 67.6%/32.4% (OR=4.3) (95% CI, 1.04 to 8.8), (p=0.038). The 58 migraine sufferers were divided in two groups: Group 1, 39 subjects with ASD, mean age 34 years old (SD 11), 93% female gend e r. Group 2, 19 subjects without ASD, mean age 35 years old (SD 9.6), 68% female gender. When asked about the occurrence of more than three migraine crises in the last month, 76.7% of Group 1 and 60% of Group 2 answered yes (OR=1.56; p=0.2; 95% CI , 0.6 to 7.6). Aura occurred in 65.1% of the Group 1 and 40% of the Group 2 (OR=2.8; 95% CI, 0.8 to 9.3; p=0.08).Conclusion: These results suggest that ASD is a risk factor for migranine and that migraine carriers with ASD have higher tendency for the occurrence of aura and a higher number of migraine crises for month than migraine carriers without ASD.