Headaches in Children After Transcatheter Device Closure of Atrial Septal Defects: A Single-Centre Experience
Joshua D Griesman1, Audrey C Marshall1
1Department of Paediatrics, Division of Cardiology, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Transcatheter device closure (TDC) for atrial septal defects in children may cause new-onset headaches in about 15% of patients. This finding is similar to adult rates and can help inform pre-procedure counseling for pediatric patients.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Neurology
Background:
- Transcatheter device closure (TDC) is a primary treatment for isolated atrial septal defects in children.
- Headache incidence post-TDC is known in adults (15%) but less described in pediatric populations.
- This study investigates headache occurrence in children following TDC.
Purpose of the Study:
- To estimate the incidence of new-onset headache in pediatric patients after transcatheter device closure (TDC).
- To characterize the nature and management of headaches post-TDC in children.
- To provide data for improved patient counseling before pediatric TDC procedures.
Main Methods:
- Retrospective review of pediatric patients undergoing TDC between January 2018 and December 2021.
- Comprehensive analysis of electronic medical records to identify headache complaints post-TDC.
- Inclusion criteria applied to a cohort of 134 pediatric patients.
Main Results:
- Headache was documented in 20 of 134 pediatric patients (15%) post-TDC.
- Four patients (20% of those with headaches) required further investigation or medical management changes.
- Investigations included MRI (non-pathologic), ED visits, and antiplatelet regimen adjustments.
Conclusions:
- The incidence of headache following TDC in children is estimated to be at least 15%.
- This finding highlights the need for pre-procedural counseling regarding potential headaches.
- Further prospective studies are necessary to determine the precise incidence and characteristics of post-TDC headaches in pediatric patients.
Background:
Transcatheter device closure (TDC) is the most common treatment for isolated atrial septal defects in children. In the adult population, the incidence of new-onset migraine headache after TDC is well recognized and is estimated at 15%. New-onset headache after paediatric TDC has not been well described. We reviewed our centre's experience to estimate the rate of headache complaints among paediatric patients after TDC.
Methods:
We performed a single-centre, retrospective review of all children who underwent TDC between January 1, 2018, and December 31, 2021. For the included patients, we comprehensively reviewed the electronic medical record to identify patients reported to experience post-TDC headache.
Results:
A total of 165 consecutive patients underwent TDC during the study period. Of these, 134 met inclusion criteria, and 20 patients (15%) had headache documented in the electronic medical record. Of 20 patients, 4 (20%) had headaches that led to further investigation or changed postprocedural medical management. Two patients had brain magnetic resonance imaging to investigate headaches; both studies were interpreted as nonpathologic. One patient required emergency department management for status migrainosus. A second, with a prior history of migraine, required admission for migraine exacerbation. In addition to those needing symptomatic management, 3 patients had a change in their antiplatelet regimen from aspirin to clopidogrel.
Conclusions:
Our study suggests a minimal estimate of 15% as the incidence of headache in children who undergo TDC. This estimate can inform counselling before TDC. Determination of the true incidence will require focused prospective data collection.
