Atrial septal defect migraine
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3] Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]
Overview
There is an association between the presence of an atrial septal defect and the development of migraines. While there is no data proving a causal associaion between atrial septal defects and migraines, it is notable that the repair of defects such as patent foramen ovale can reduce the severity of migraine symptoms. Additional research has indicated a number of effective medical therapies that have also reduced the incidence of migraines.
Migraine
Some recent research has suggested that a proportion of cases of migraine may be caused by patent foramen ovale. While the exact mechanism remains unclear, closure of a PFO can reduce symptoms in certain cases.[1][2] This remains controversial. 20% of the general population have a PFO, which for the most part, is asymptomatic. 20% of the female population have migraines. And, the placebo effect in migraine typically averages around 40%. The high frequency of these facts makes statistically significant relationships between PFO and migraine difficult (i.e., the relationship may just be chance or coincidence).
Although there is no direct evidence to link migraines and atrial septal defects, some research has noted that treatment of patent foramen ovale can reduce the severity of migraine symptoms.[3][4]
Effective pharmacologic therapies for migraine prevention include:
- Anti-hypertensives: Beta blockers (propranolol, timolol, metoprolol, nadolol, and atenolol), calcium channel blockers (verapamil, nifedipine, and nimodipine), and angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (lisinopril, candesartan)
- Anti-depressants: Amitriptyline, venlafaxine, nortriptyline, doxepin, protriptyline
- Anti-convulsants: Valproate, gabapentin, topiramate
- Other prophylaxis: Botuliunum toxin, butterbur, coenzyme Q10, feverfew, magnesium, methysergide, opioids, pizotifen, riboflavin
References
- ↑ Adams H (2004). "Patent foramen ovale: paradoxical embolism and paradoxical data". Mayo Clin Proc. 79 (1): 15–20. PMID 14708944.
- ↑ Azarbal B, Tobis J, Suh W, Chan V, Dao C, Gaster R (2005). "Association of interatrial shunts and migraine headaches: impact of transcatheter closure". J Am Coll Cardiol. 45 (4): 489–92. PMID 15708691.
- ↑ Azarbal B, Tobis J, Suh W, Chan V, Dao C, Gaster R (2005). "Association of interatrial shunts and migraine headaches: impact of transcatheter closure". J Am Coll Cardiol. 45 (4): 489–92. PMID 15708691.
- ↑ Adams H (2004). "Patent foramen ovale: paradoxical embolism and paradoxical data". Mayo Clin Proc. 79 (1): 15–20. PMID 14708944.