Migraine Symptoms Related to the Percutaneous Closure of An Ostium Secundum Atrial Septal Defect: Report of Four Paediatric Cases and Review of the Literature

Abstract

Several publications have recently suggested that atrial septal defect may be associated with the physiopathology of headache with migraine-type characteristics. We describe four previously asymptomatic paediatric patients with atrial septal defect who underwent percutaneous Amplatzer septal occluder device implantation and who subsequently developed symptoms compatible with migraine headache. The cases had normal echocardiograms after the intervention and a benign course with headache improvement after several weeks or months. There are paediatric patients with atrial septal defect who may dramatically develop migraine symptoms with or without aura following percutaneous correction of their defect. Large paediatric studies are needed to offer accurate prognoses for children and their families. The possibility of using clopidogrel to treat this type of headache is subject to debate.

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

“…In four of the case studies (57, 73, 78, 92) antithrombotics ameliorated, reduced, or abolished MA events; in one study, the thienopyridine appeared ineffectual (75). In three studies, MH disappeared at 4 months (92), 6 months (57), and at 9 months (75). However, although MH disappeared in one of the patients, aura without headache persisted at 2-year follow-up (75).…”

“…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).…”

“…Eight of 25 studies included pediatric patients (46, 51, 52, 58, 76, 78, 92, 93). Occurrence of de novo MH has been reported to not differ significantly between pediatric and adult patients (51) (Vijarnsorn Beneficial 2012), though, antithetically, other research reports higher de novo MH prevalence among pediatric patients (46, 76) and younger adult patients (46, 61).…”

“…Adult patients were involved in three of the five case studies reporting de novo MH after pASDC (57, 73, 75), and pediatric patients were involved in the remaining two studies (78, 92). All de novo case study MH events occurred within 7 days of closure and were type MA.…”

“…The substantial impact of the procedure itself was underlined by the early post implantation change in MH status. While more than a few studies (63, 65, 69, 70, 75, 77, 78, 80) reported MH change within hours of the procedure, by 7 days after implantation 12% (11/91) of patients with preexisting MH underwent MH change (mainly in frequency or severity), and the initial onset of de novo MH occurred in 34% (52/153) of de novo cases. While type of MH was not differentiated in 20% of de novo MH patients (31/153), data that were available indicated de novo MA within 7 days from pASDC accounted for MH debut in 48% of de novo MH cases (25/52) and de novo MO within 7 days from implantation accounted for MH debut in 12% of patients (6/52).…”