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A New Perspective of Migraine Symptoms in Patients With Congenital Heart Defect

Yinglu Liu¹, Sulei Li², Rongfei Wang¹

¹Department of Neurology, Chinese PLA General Hospital, Beijing, China.

|November 17, 2018

Insights

Congenital heart defects (CHDs) are associated with migraine, particularly a larger closure-to-defect size ratio, which is a risk factor for new-onset migraine. Transcatheter closure may relieve migraine symptoms in some patients.

Area of Science:

Cardiology
Neurology
Medical Devices

Background:

Congenital heart defects (CHDs) encompass a range of conditions affecting heart structure at birth.
Migraine is a common neurological disorder with complex and not fully understood etiologies.
The relationship between CHDs and migraine, especially concerning transcatheter closure, warrants further investigation.

Purpose of the Study:

To investigate the association between congenital heart defects (CHDs) and migraine.
To evaluate the efficacy of transcatheter defect closure in patients with CHDs and migraine.
To explore potential risk factors for new-onset migraine after defect closure.

Main Methods:

Retrospective analysis of 441 CHD patients who underwent transcatheter defect closure (2006-2017).
Assessment of migraine using the 3-item ID Migraine Screener and detailed questionnaires.
Patients categorized by defect type (VSD, ASD/PFO) and shunt direction (RLS/LRS), and migraine status (PM, RM, WM, NM).

Main Results:

Patients with right-to-left shunts (RLS) had a higher prevalence of migraine.
A larger ratio of closure device size to defect size (R) was significantly associated with new-onset migraine (NM) in the atrial septal defect/patent foramen ovale (ASD/PFO) group.
Migraine symptoms significantly decreased post-closure in persistent migraine (PM) patients with ASD and PFO.

Conclusions:

A significant association exists between CHDs and migraine.
The ratio of closure device size to defect size is a potential risk factor for new-onset migraine.
Further research, including randomized controlled trials, is necessary to elucidate the CHDs-migraine link.

Read full analysis

Abstract

Objective:

To investigate the association between congenital heart defects (CHDs) and migraine and evaluate the efficacy of transcatheter defect closure from a new perspective.

Methods:

The patients with CHDs who underwent transcatheter defect closure were screened in the medical database of Chinese PLA General Hospital from January 2006 to January 2017. The assessment included basic admission information, the 3-item ID Migraine Screener, and a detailed questionnaire administered by telephone or in an outpatient clinic. Patients were divided into ventricular septal defect (VSD) group and AP group (ie, patients with ASD or PFO) based on the type of defects. The latter group could be further divided into right-to-left shunt (RLS) group and left-to-right (LRS) shunt group. Each group contained 4 subgroups according to their migraine diagnosis before and after defect closure: persistent migraine (PM), relieved migraine (RM), without migraine (WM), and new-onset migraine (NM).

Results:

The study recruited total 441 CHDs patients. Most patients in RLS group had migraine before and/or after surgery (76.4%, 42/55) and the proportion of them in NM group was higher than that of in LRS group (23.5%, 4/17 vs 6.8%, 18/266, P = .0418). Although the size of closure device or defect did not show significant differences, the ratios (R = size of closure/size of defect) were significantly higher in NM group than those in WM group (1.40 [1.26, 1.80] vs 1.22 [1.13, 1.38] in AP group, P = .00238; 1.38 [1.23, 1.50] vs 1.22 [1.13, 1.37] in LRS group, P = .024934, respectively). Further logistic regression analysis illustrated that larger R value was a risk factor for NM in AP group (OR 1.48, 95% CI 1.07-2.05, P = .0188). Besides, migraine symptoms decreased significantly after defect closure in PM group among patients with ASD and PFO.

Conclusion:

This study revealed several associations between migraine and CHDs, especially the large ratio of closure device size to defect size. High-quality randomized controlled trials and animal studies are needed to further investigate and clarify the underlying association between CHDs and migraine.

Keywords:

congenital heart defect migraine right-to-left shunt transcatheter defect closure

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