Effect of Clopidogrel and Aspirin vs Aspirin Alone on Migraine Headaches After Transcatheter Atrial Septal Defect Closure

Abstract

Adding clopidogrel to aspirin for 3 months after transcatheter atrial septal defect (ASD) closure results in a lower incidence of new-onset migraine attacks. However, the outcomes at 6-to 12-month follow-up (after clopidogrel cessation at 3 months) remain largely unknown.OBJECTIVE To assess the incidence of migraine attacks at 6-and 12-month follow-up after transcatheter ASD closure. DESIGN, SETTING, AND PARTICIPANTSThis prespecified analysis of a randomized, double-blind clinical trial included patients with no prior history of migraine undergoing ASD closure from 6 university hospitals in Canada from December 2008 to November 2014. Patients were followed up at 3, 6, and 12 months, and a migraine headache questionnaire was administered at each time. Analysis began June 2019.INTERVENTIONS Patients were randomized (1:1) to receive dual antiplatelet therapy (aspirin plus clopidogrel; n = 84) vs single antiplatelet therapy (aspirin plus placebo; n = 87) for 3 months following transcatheter ASD closure. After 3 months, only single antiplatelet therapy (aspirin) was pursued. MAIN OUTCOMES AND MEASURESIncidence and severity of migraine attacks at 6-and 12-month follow-up. RESULTSThe mean (SD) age of the study population was 38 (12) years, with 106 women (62%). A total of 27 patients (15.8%) had new-onset migraine attacks within the 3 months following ASD closure (8 of 84 [9.5%] vs 19 of 87 [21.8%] in the initial clopidogrel and placebo groups, respectively; P = .03). After cessation of clopidogrel and aspirin monotherapy, the percentage of patients with migraine attacks decreased over time, with 8 (4.7%) and 4 patients (2.3%) continuing to have migraine attacks at 6 and 12 months, respectively (vs 3 months: P < .001). The severity of migraine attacks progressively decreased over time; no moderate or severe attacks occurred at 6 and 12 months (vs 3 months: P < .001). There were no differences between groups in the rate of migraine attacks at 6 months (initial clopidogrel group: 2 of 84 [2.4%]; initial placebo group: 6 of 87 [6.9%]; P = .28) and 12 months (initial clopidogrel group: 3 of 84 [3.6%]; initial placebo group: 1 of 87 [1.1%]; P = .36) after ASD closure. Only 2 patients (1.2%; 1 patient per group) presented with new-onset migraine attacks after 3 months.CONCLUSIONS AND RELEVANCE New-onset migraine attacks after ASD closure improved or resolved spontaneously within 6 to 12 months in most patients. No significant rebound effect was observed after clopidogrel cessation at 3 months. These results demonstrate a low rate of migraine events beyond 3 months following transcatheter ASD closure and support the early discontinuation of clopidogrel therapy if administered.

Effects of Different Doses of Clopidogrel plus Early Rehabilitation Therapy on Motor Function and Inflammatory Factors in Patients with Ischemic Stroke

“…The levels of inflammatory factors decreased in both groups, with lower results observed in the high-dose group versus the low-dose group. High-dose clopidogrel better promotes reperfusion in the ischemic penumbra, shrinks the infarct volume, increases neuronal activity, attenuates the degree of cerebral ischemic injury, alleviates the inflammatory response of the body, increases the blood flow supply to the ischemic brain, facilitates the improvement of prognosis, and improves the ability of patients in daily life, which is consistent with the findings by Liang Hua [ 13 – 16 ]. It has been reported that patients with ischemic stroke may experience abnormal motor function such as hemiparesis after treatment, which dramatically compromises their daily life.…”

Çocuklarda, Ergenlerde ve Genç Yetişkinlerde Transtorasik Ekokardiyografi ve Floroskopi Kılavuzluğunda Cihazla Transkateter Atriyal Septal Defekt Kapatılması

“…In one study, new-onset or increased postprocedural migraine headaches were reported in 7 of 150 patients who underwent transcatheter patent foramen ovale or ASD closure (27). Migraine-like headache related to nickel allergy generally lasts for several months and is controllable with aspirin, acetaminophen, or clopidogrel (25,28). In our study, there was one patient with a migraine-like headache due to nickel allergy, his symptoms completely resolved in 3 months with medical treatment.…”

“…The activation of local inflammatory reaction by the device that causes the formation of platelet adhesions or release of inflammatory mediators into the left atrium is thought to be the possible mechanism of migraine-like headache (25,26).…”

Severe headache in a middle-aged woman after device closure of a ventricular septal defect

“…Although it is most common in middle-aged women, the cause or pathophysiology is not clear. 6 Risk factors of reversible cerebral vasoconstriction syndrome are associated with medicine like cannabis, vasoconstrictive drugs, or steroid. 2 As indicated by its name, reversible cerebral vasoconstriction syndrome improves without treatment, although calcium channel blockers such as nimodipine might help.…”