Advertisement

Migraine headaches following catheter ablation for atrial fibrillation

  • Amit Noheria
  • John Roshan
  • Suraj Kapa
  • Komandoor Srivathsan
  • Douglas L. Packer
  • Samuel J. AsirvathamEmail author
Article

Abstract

Background

Atrial septal defects (ASD), including patent foramen ovale, have been linked to an increased prevalence of migraine headaches in the general population. A similar association with migraine is speculated for iatrogenic ASD due to atrial septal puncture during catheter ablation for atrial fibrillation (AF).

Methods

A total of 2,069 patients who underwent catheter ablation for AF at Mayo Clinic, Rochester, MN between January 2001 and December 2008 were scheduled for follow-up at least at 3 months and annually thereafter. Data were collected from the questionnaires patients answered at follow-up inquiring about presence and characteristics of any headaches following the procedure and further chart review. Definite migraine was diagnosed based on clinical features per the International Classification of Headache Disorder-II definition.

Results

Twenty-two patients (1.1%) had a new-onset definite migraine, 12 (0.6%) had a new-onset probable migraine, ten (0.5%) with a previous history of migraine had worsened headaches, and four (0.2%) had headache due to an alternate identifiable cause; a total of 48 patients (2.3%) reported post-procedural headaches. Nineteen of 22 patients (86%) with definite migraine had complete resolution of symptoms at 1- to 2-year follow-up.

Conclusion

New-onset migraine is an uncommon and usually temporary side effect of catheter ablation for AF. The mechanism for post-procedure headache remains unclear.

Keywords

Migraine Atrial fibrillation Catheter ablation Patent foramen ovale Atrial septal defect Follow-up 

Abbreviations

AF

Atrial fibrillation

ASD

Atrial septal defect

PFO

Patent foramen ovale

TEE

Transesophageal echocardiography

Notes

Conflicts of interest

None.

References

  1. 1.
    De Ponti, R., Cappato, R., Curnis, A., Della Bella, P., Padeletti, L., Raviele, A., et al. (2006). Trans-septal catheterization in the electrophysiology laboratory: data from a multicenter survey spanning 12 years. Journal of the American College of Cardiology, 47, 1037–1042.PubMedCrossRefGoogle Scholar
  2. 2.
    Srivathsan, K., Monahan, K., Asirvatham, S. J., & Packer, D. L. (2005). Migraine and visual symptoms after ablation of atrial fibrillation (Abstract 2633). Circulation, 112(17 Suppl), II-554.Google Scholar
  3. 3.
    Chilukuri, K., Sinha, S., Berger, R., Marine, J. E., Cheng, A., Nazarian, S., et al. (2009). Association of transseptal punctures with isolated migraine aura in patients undergoing catheter ablation of cardiac arrhythmias. Journal of Cardiovascular Electrophysiology, 20(11), 1227–1230.PubMedCrossRefGoogle Scholar
  4. 4.
    Tepper, S. J., Cleves, C., & Taylor, F. R. (2009). Patent foramen ovale and migraine: association, causation, and implications of clinical trials. Current Pain and Headache Reports, 13, 221–226.PubMedCrossRefGoogle Scholar
  5. 5.
    Rillig, A., Meyerfeldt, U., Birkemeyer, R., Treusch, F., Kunze, M., & Jung, W. (2008). Persistent iatrogenic atrial septal defect after pulmonary vein isolation: incidence and clinical implications. Journal of Interventional Cardiac Electrophysiology, 22, 177–181.PubMedCrossRefGoogle Scholar
  6. 6.
  7. 7.
    Gage, B. F., Waterman, A. D., Shannon, W., Boechler, M., Rich, M. W., & Radford, M. J. (2001). Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation. Journal of the American Medical Association, 285, 2864–2870.PubMedCrossRefGoogle Scholar
  8. 8.
    Saravanan, P., Lang, C., & Davidson, N. (2009). Migraine following trans-septal access for catheter ablation of cardiac arrhythmias. Headache, 49, 1065–1067.PubMedCrossRefGoogle Scholar
  9. 9.
    Anzola, G. P., Magoni, M., Guindani, M., Rozzini, L., & Dalla Volta, G. (1999). Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology, 52, 1622–1625.PubMedGoogle Scholar
  10. 10.
    Magalhaes, E., Torreao, J., Dias, J., Cardoso, E., & Melo, A. (2005). Atrial septal defects as a risk factor for migraine: a case–control study. Arquivos de Neuropsiquiatria, 63, 1042–1046.Google Scholar
  11. 11.
    Wilmshurst, P. T., Pearson, M. J., Nightingale, S., Walsh, K. P., & Morrison, W. L. (2004). Inheritance of persistent foramen ovale and atrial septal defects and the relation to familial migraine with aura. Heart (British Cardiac Society), 90, 1315–1320.CrossRefGoogle Scholar
  12. 12.
    Garg, P., Servoss, S. J., Wu, J. C., Bajwa, Z. H., Selim, M. H., Dineen, A., et al. (2010). Lack of association between migraine headache and patent foramen ovale: results of a case–control study. Circulation, 121, 1406–1412.PubMedCrossRefGoogle Scholar
  13. 13.
    Rundek, T., Elkind, M. S., Di Tullio, M. R., Carrera, E., Jin, Z., Sacco, R. L., et al. (2008). Patent foramen ovale and migraine: a cross-sectional study from the Northern Manhattan Study (NOMAS). Circulation, 118, 1419–1424.PubMedCrossRefGoogle Scholar
  14. 14.
    Azarbal, B., Tobis, J., Suh, W., Chan, V., Dao, C., & Gaster, R. (2005). Association of interatrial shunts and migraine headaches: impact of transcatheter closure. Journal of the American College of Cardiology, 45, 489–492.PubMedCrossRefGoogle Scholar
  15. 15.
    Rigatelli, G., Dell’Avvocata, F., Ronco, F., Cardaioli, P., Giordan, M., Braggion, G., et al. (2010). Primary transcatheter patent foramen ovale closure is effective in improving migraine in patients with high-risk anatomic and functional characteristics for paradoxical embolism. Journal of the American College Cardiology: Cardiovascular Interventions, 3, 282–287.Google Scholar
  16. 16.
    Rigatelli, G., Braggion, G., Aggio, S., Chinaglia, M., & Cardaioli, P. (2006). Primary patent foramen ovale closure to relieve severe migraine. Annals of Internal Medicine, 144, 458–460.PubMedGoogle Scholar
  17. 17.
    Rigatelli, G., Cardaioli, P., Dell’Avvocata, F., Giordan, M., Braggion, G., Chinaglia, M., et al. (2010). Transcatheter patent foramen ovale closure is effective in reducing migraine independently from specific interatrial septum anatomy and closure devices design. Congenital Heart Disease, 11, 29–33.Google Scholar
  18. 18.
    Mortelmans, K., Post, M., Thijs, V., Herroelen, L., & Budts, W. (2005). The influence of percutaneous atrial septal defect closure on the occurrence of migraine. European Heart Journal, 26, 1533–1537.PubMedCrossRefGoogle Scholar
  19. 19.
    Voet, A., Luermans, J. G., Thijs, V., Herroelen, L., Post, M. C., Troost, E., et al. (2008). New-onset and persistent migraine early after percutaneous atrial septal defect closure disappear at follow-up. Acta Clinica Belgica, 63, 262–268.PubMedGoogle Scholar
  20. 20.
    Rodes-Cabau, J., Mineau, S., Marrero, A., Houde, C., Mackey, A., Cote, J. M., et al. (2008). Incidence, timing, and predictive factors of new-onset migraine headache attack after transcatheter closure of atrial septal defect or patent foramen ovale. The American Journal of Cardiology, 101, 688–692.PubMedCrossRefGoogle Scholar
  21. 21.
    Dowson, A., Mullen, M. J., Peatfield, R., Muir, K., Khan, A. A., Wells, C., et al. (2008). Migraine intervention with STARFlex technology (MIST) trial: a prospective, multicenter, double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache. Circulation, 117, 1397–1404.PubMedCrossRefGoogle Scholar
  22. 22.
    Butera, G., Biondi-Zoccai, G. G., Carminati, M., Caputi, L., Usai, S., Bussone, G., et al. (2010). Systematic review and meta-analysis of currently available clinical evidence on migraine and patent foramen ovale percutaneous closure: much ado about nothing? Catheterization and Cardiovascular Interventions, 75, 494–504.PubMedGoogle Scholar
  23. 23.
    Wilmshurst, P., & Nightingale, S. (2006). The role of cardiac and pulmonary pathology in migraine: a hypothesis. Headache, 46, 429–434.PubMedCrossRefGoogle Scholar
  24. 24.
    Thenganatt, J., Schneiderman, J., Hyland, R. H., Edmeads, J., Mandzia, J. L., & Faughnan, M. E. (2006). Migraines linked to intrapulmonary right-to-left shunt. Headache, 46, 439–443.PubMedCrossRefGoogle Scholar
  25. 25.
    Post, M. C., Thijs, V., Schonewille, W. J., Budts, W., Snijder, R. J., Plokker, H. W., et al. (2006). Embolization of pulmonary arteriovenous malformations and decrease in prevalence of migraine. Neurology, 66, 202–205.PubMedCrossRefGoogle Scholar
  26. 26.
    Luermans, J. G., Post, M. C., Temmerman, F., Thijs, V., Schonewille, W. J., Plokker, H. W., et al. (2009). Is a predominant left-to-right shunt associated with migraine?: a prospective atrial septal defect closure study. Catheterization and Cardiovascular Interventions, 74, 1078–1084.PubMedCrossRefGoogle Scholar
  27. 27.
    Di Fabio, R., Giugni, E., Angeloni, I., Vanacore, N., Casali, C., Pierallini, A., et al. (2009). Contrast echocardiography and migraine in divers with patent foramen ovale. The Canadian Journal of Neurological Sciences, 36, 740–744.PubMedGoogle Scholar
  28. 28.
    Koyama, S., & Kawamura, M. (2007). Persistent visual aura following catheter ablation in a patient with WPW syndrome. Behavioural Neurology, 18, 187–192.PubMedGoogle Scholar
  29. 29.
    Schwedt, T. J. (2009). The migraine association with cardiac anomalies, cardiovascular disease, and stroke. Neurologic Clinics, 27, 513–523.PubMedCrossRefGoogle Scholar
  30. 30.
    Castellini P, Lambru G, Manzoni GC, Torelli P (2009). Atrial septal defect closure and migraine with aura: is there a correlation? Neurological Sciences (in press).Google Scholar
  31. 31.
    Kovacs, K., Herman, F., Filep, J., Jelencsik, I., Magyar, K., & Csanda, E. (1990). Platelet aggregation of migraineurs during and between attacks. Cephalalgia, 10, 161–165.PubMedCrossRefGoogle Scholar
  32. 32.
    Lim, B., Venkatachalam, K. L., Jahangir, A., Johnson, S. B., & Asirvatham, S. J. (2008). Concurrent application of charge using a novel circuit prevents heat-related coagulum formation during radiofrequency ablation. Journal of Cardiovascular Electrophysiology, 19, 843–850.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Amit Noheria
    • 1
  • John Roshan
    • 2
  • Suraj Kapa
    • 3
  • Komandoor Srivathsan
    • 4
  • Douglas L. Packer
    • 1
  • Samuel J. Asirvatham
    • 1
    Email author
  1. 1.Division of Cardiovascular DiseasesMayo Clinic College of MedicineRochesterUSA
  2. 2.Department of CardiologyChristian Medical CollegeVelloreIndia
  3. 3.Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaUSA
  4. 4.Division of Cardiovascular DiseasesMayo ClinicPhoenixUSA

Personalised recommendations