Abstract
In contrast to patent foramen ovale, that is highly prevalent in the general population, atrial
septal defect (ASD) is a rare congenital heart defect. The effect of ASD closure on headache
and migraine remains a matter of controversy. The objectives of the study were (i) to
determine headache prevalence in consecutive patients with ASD scheduled for percutaneous
closure for cardiologic indications, using the classification of the International Headache
Society and (ii) to compare headache characteristics before and after closure of ASD. In this
observational case series no a priori power analysis was performed. Twenty-five consecutive
patients were prospectively included over 27 months. Median duration of follow-up was 12
months, [Interquartile range 0]. Prevalence of active headache seemed to be increased
compared to the general population: Any headaches 88% (95% confidence interval 70-96),
migraine without aura 28% (14-48), migraine with aura 16% (6-35). After ASD closure, we
observed a slightly lower headache frequency (median frequency 1.0 [2.6] vs. 0.3 [1.5]
headaches per month; p=0.067). In patients with ongoing headaches, a significant decrease in
headache intensity (median VAS 7 [3] vs. 5 [4]; p=0.036) was reported. Three patients with
migraine with aura before the intervention reported no migraine with aura attacks at followup,
two of them reported ongoing tension-type headache, one migraine without aura. In
summary, this prospective observational study confirms the high prevalence of headache,
particularly migraine, in ASD patients and suggests a possible small beneficial effect of ASD
closure.
Riederer, F