The Burden of Migraine in Adults with Atrial Septal Defect: A Nationwide Cohort Study

Nyboe, Camilla; Nymann, Ann Hyldahl; Ovesen, Anne-Sif; Hjortdal, Vibeke E.

doi:10.1038/s41598-019-43895-z

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…The association between ASD and migraine has been reported previously [ 22 , 23 ]. It is well known that already existing migraine can worsen in the first month following the ASD closure [ 5 ].…”

Section: Discussionmentioning

confidence: 59%

“…In our study, we showed that the risk for new-onset migraine was markedly increased (RR 3.61) even after the shunt was closed, and the risk seemed to remain elevated in the long-term follow-up. In a Danish register-based study, the hazard ratio for new migraine was even higher (HR 5.5) after the ASD closure [ 23 ]. The rate of new-onset migraine was 8.2% in our study, which is consistent with previous studies (0–24%) [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Outcome of transcatheter atrial septal defect closure in a nationwide cohort

et al. 2023

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Background Transcatheter (TC) atrial septal defect (ASD) closure has been the mainstay of therapy for secundum-type ASDs for over 20 years. Aims This nationwide cohort evaluated the long-term outcome of transcatheter-closed ASDs. Methods The study enrolled every transcatheter ASD closure performed in Finland from 1999 to 2019. Five age, sex, and municipality-matched controls per ASD patient were gathered from the general population. The median follow-up period was 5.9 years (range 0–20.8). We used the hospital discharge register to gather all hospital visits and diagnoses. Closure complications and echocardiographic changes were collected from the electronic health records. Results Transcatheter ASD closure was performed in 1000 patients (68.5% females) during the study period. The median (range) age at the time of the procedure was 37.9 (1.8–87.5) years. ASD patients had an increased risk for new-onset atrial fibrillation (RR 2.45, 95% CI: 1.84–3.25), migraine (RR 3.61, 95% CI: 2.54–5.14), ischemic heart disease (RR 1.73, 95% CI: 1.23–2.45), ventricular fibrillation/tachycardia (RR 3.54 (95% CI: 1.48–8.43) and AV conduction disorder (RR 3.60, 95% CI: 1.94–6.70) compared to the control cohort. Stroke risk was not increased (RR 1.36, 95% CI: 0.91–2.03). Adverse events occurred in 6.3% ( n = 63) of the patients, including four erosions and ten device embolizations. Conclusion After TC closure of ASD, patients had a higher risk of new-onset atrial fibrillation and migraine than controls without ASD . As novel findings, we found an increased risk for ischemic heart disease, AV conduction disorders, and ventricular fibrillation/tachycardia. Key messages Even though patients have an excellent overall prognosis after percutaneous ASD closure, the increased incidence of major comorbidities like atrial fibrillation and heart failure prompts more thorough lifelong follow-up. This study’s novel findings revealed the increased risk for ischemic heart disease, AV conduction disorders, or ventricular tachycardia/fibrillation during the follow-up. Major complications after the closure are rare; erosion is seen in 0.4% of the patients and embolization in 1.0% of the patients.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Outcome of transcatheter atrial septal defect closure in a nationwide cohort

et al. 2023

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“…A chronic low serotonin disposition in the brain has been recognized as one of the leading biochemical pathogenesis of migraine, and a sudden increase of serotonin represents a crucial trigger of migraine attacks [ 31 ]. A cohort study investigating the burden of migraine and levels of serotonin in adults with an atrial septal defect found that patients with atrial septal defect had an increased risk of receiving a migraine diagnosis (hazard ratio: 3.4, 95% CI: 2.6 to 4.6) and plasma serotonin was severely elevated [ 32 ]. Besides, a model of endothelial dysfunction in the trigeminovascular system has emerged in migraine research recently, which induces an inflammatory response and a hypercoagulable state marked by increased platelet reactivity, altered erythrocyte morphology and metabolism, and increased fibrinogen levels [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Platelet P2Y12 Inhibitor in the Treatment and Prevention of Migraine: A Systematic Review and Meta-Analysis

Wang

Cao

Liu

et al. 2022

Behavioural Neurology

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There have been speculation and research linking migraine with abnormalities of platelet aggregation and activation. The role of the P2Y12 platelet inhibitor in the treatment of migraine has not been established. We aim to evaluate the efficacy of the platelet P2Y12 inhibitor in the treatment of migraine and prevention of new-onset migraine headache (MHA) following transcatheter atrial septal defect closure (ASDC). We searched the PubMed, Web of Science, and Cochrane Library databases for relevant studies. The primary outcomes were the headache responder rate and the rate of new-onset migraine attacks following ASDC. Four studies for a total of 262 migraine patients with or without patent foramen ovale (PFO) and three studies involving 539 patients with antiplatelet treatment in the prevention of new-onset migraine following ASDC were included. The pooled responder rate of the P2Y12 inhibitor for migraine was 0.64 (95% CI: 0.43 to 0.81). For patients who underwent ASDC, the use of antiplatelet regimens including the P2Y12 inhibitor, compared with regimens excluding P2Y12 inhibitor, resulted in a lower rate of new-onset migraine (OR: 0.41, 95% CI: 0.22 to 0.77, P = 0.005 ). We concluded that the P2Y12 platelet inhibitor may have a primary prophylactic role in migraine patients with or without PFO and prevent new-onset MHA after ASDC. The responsiveness of the P2Y12 inhibitor could help select candidates who would benefit from PFO closure. It warrants further large-scale research to explore the role of the P2Y12 inhibitor, particularly in a proportion of migraine patients.

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Atrial Septal Defects

Hahurij,

Bökenkamp

2023

Pediatric Cardiology

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The Burden of Migraine in Adults with Atrial Septal Defect: A Nationwide Cohort Study

Cited by 7 publications

References 25 publications

Outcome of transcatheter atrial septal defect closure in a nationwide cohort

Outcome of transcatheter atrial septal defect closure in a nationwide cohort

Platelet P2Y12 Inhibitor in the Treatment and Prevention of Migraine: A Systematic Review and Meta-Analysis

Atrial Septal Defects

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