Journal of Invasive Cardiology

Interatrial septal defects (IASD) have been associated with an increased incidence of cryptogenic strokes.^1–7 Percutaneous closure of these defects is now widely performed and the safety of this procedure has been established. It is unclear, however, how effective IASD closure is in preventing further recurrences of strokes or transient ischemic events (TIA) when compared to traditional treatment with anticoagulation. Observational data, however suggest that IASD closure in patients with a history of cryptogenic stroke reduces the frequency and intensity of migraine headaches (HA) in migraine sufferers.^8–12 In this study, we retrospectively reviewed our own experience with IASD closure and its relationship to the frequency and intensity of migraine HA in patients with a history of unexplained strokes or TIAs.

Methods

Fifty-eight consecutive patients with a history of unexplainable stroke or TIA with the exception of the presence of an IASD were included in this retrospective study that was approved by the Institutional Review Board at our institution. Patients were included in this study if they had a clinically or neuroradiologically confirmed ischemic stroke with no other identifiable cause, with the exception of an IASD. Patients were ruled out for cerebrovascular disease, arrhythmias and coagulation disorders. All patients have a documented IASD by saline contrast injection and have undergone closure of this defect percutaneously using either the Amplatzer occluder (AGA Medical, Plymouth, Minnesota) (for atrial septal defect [ASD]) or the CardioSEAL occluder (NMT Medical, Inc., Boston, Massachusetts) (for patent foramen ovale [PFO]). Patients were routinely followed at 1 month, 6 months and then annually postprocedure. Data were collected from medical records and by follow-up phone interviews.
Multiple variables were collected including age, gender, history of smoking, hypertension, diabetes, hypercholesterolemia, ejection fraction, anticoagulants use pre- and postprocedure, shunt grade across the IASD pre- and postprocedure, defect size, size of IASD, degree of shunt, presence of atrial septal aneurysm and right-sided filling pressures.
Patients with a history of migraine HA answered the Migraine Disability Assessment Test (MIDAS), a standardized migraine questionnaire. Two questionnaires relating to the intensity and frequency of migraines HA were filled by each patient; one describing migraine HA within 3 months prior to the index procedure (retrospective), and one within 3 months prior to the follow-up interview (prospective). Patients were also asked about whether they had aura defined as the presence of visual or focal neurologic symptoms prior to the onset of their migraine HA. Descriptive analyses were performed on all variables and were compared among migraine and nonmigraine HA patients. Pre- and postclosure intensity and frequency of migraine HA were compared using the Wilcoxon paired test.