Calcitonin Gene‐Related Peptide and Size of the Atrial Septal Defect in New‐Onset Migraine After Transcatheter Closure: Results of a Preliminary Study

Abstract

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.

Migraine Modulation and Debut after Percutaneous Atrial Septal Defect Closure: A Review

“…De novo MH following pASDC was reported in two of three prospective studies (71, 72). Luermans et al (71) reported de novo MH in 4/63 patients (6%) after the procedure.…”

“…In terms of study type, change in preexisting MH was reported in 3 of 8 case studies (62, 70, 82); 2 of 3 prospective studies (71, 84), and in 9 of 13 retrospective studies (19, 52, 59–61, 63, 64, 76, 81). De novo MH was reported in 5 of 8 case studies (57, 73, 75, 78, 92), in 2 of 3 prospective studies (71, 72), and in 11 of 13 retrospective studies (19, 46, 51, 52, 58, 61, 64, 67, 77, 81, 93). Finally, a recent randomized controlled trial reported de novo MH following pASDC (79).…”

“…Nevertheless, preexisting MH persisted beyond final follow-up in 79/126 (63%) of patients with a prior history of MH. Similarly, in de novo MH patients, indications were for significant reduction (81) or a course of gradual decreased frequency and general improvement (46, 72, 76, 81), but MH persisted beyond final follow-up in 116/153 (76%) patients. Instances of de novo MH perpetuating beyond 2 years [(78): three pediatric patients], 5 years [(58): one pediatric patient], and 7 years [(73): one adult] were reported.…”

“…generally did not differ significantly between those who did and those who did not experience pASDC migraine status change—change in preexisting MH or de novo MH. However, Wei et al (72) reported significantly larger ASD size and ASD length to occluder length ratio in de novo MH patients, and Mortelmans et al (61) reported significantly larger ASD size in de novo patients (and in patients with preexisting MH change after pASDC). There was a 93% rate of successful ASD closure within follow-up, and major adverse events were rare.…”

“…In 74/153 patients (48%) with de novo MH, gender of patients with MH debut was not specified. Effective modulation of MH status by antithrombotics was expressly reported in 11/25 or 44% of studies (19, 57, 63, 64, 70, 72, 73, 76, 78, 79, 82). Acetylsalicylic acid (ASA) was used in 21/25 (84%) studies, and the thienopyridine clopidogrel was used in conjunction with ASA in 12/25 (48%) of studies.…”