Page 30 - Journal of Structural Heart Disease Volume 2, Issue 5

Letter to the Editor
Journal of Structural Heart Disease, October 2016, Volume 2, Issue 5:231-233
DOI: http://dx.doi.org/10.12945/j.jshd.2016.012.15
Received: December 11, 2015 Accepted: December 12, 2015 Published online: October 2016
Migraine Reduction After Transcatheter Closure of Interatrial Septal Defects: Another Brick in the Wall?
Migraine Reduction after ASD Closure
Mark Reisman, MD1*, Elizabeth M. Perpetua, DNP2
1 Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
2 Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
Key Words
Migraine • Interatrial septal defects
Copyright © 2016 Science International Corp.
Migraine is one of the most common medical diag- noses, a ecting 13% of adult population, or 1 in 4 households, in the U.S [1]. Migraines frequently occur between 25 and 55 years of age, resulting in major limitations on quality of life and economic opportuni- ty during our most generative years of life. The socie- tal and economical implications include 112 million bedridden days per year and costs exceeding over $15 billion due to work loss [2]. Despite their preva- lence and burden, migraines remain a sorely underdi- agnosed and undertreated disability [1].
In Wilmhurst and colleagues’ seminal trial [3], mi- graine relief was a serendipitous nding in select pa- tients who underwent patent foramen ovale (PFO) closure for decompression illness and stroke. Similar ndings in multiple retrospective cohorts [4-6] spurred the eld to focus its sights on PFO closure in the setting of cryptogenic stroke.
A provocative, albeit opaque, relationship emerged between right-to-left shunt (RLS), migraines, and PFO closure. Cryptogenic stroke patients were twice as likely to have a history of migraine headaches as
those without PFO (27% versus 14%, respectively) [7]. PFO was seen more frequently in people with migraine with aura than in age- and sex-matched controls (47% versus 17%, respectively) [8]. Headache activation af- ter atrial septal defect (ASD) closure, speci cally with Nitinol-based devices (Amplatzer), was reported, en- couraging further investigation [9, 10]. All that was necessary was a prospective clinical trial, designed to account for the placebo e ect and adjudicated by mi- graine neurologists: the Migraine Intervention with StarFlex Technology (MIST) trial [11].
Many interventional cardiologists were optimistic; we saw dramatic life changes in our patients. Other- wise healthy individuals with cryptogenic stroke who were debilitated, not by residual neurological defects, but by crippling migraine headaches, returned to our clinics months later reporting life-altering improve- ments in headache frequency and severity.
The construct collapsed with a negative trial, critiquedforitsdesign,operators,patientselection, marginally e ective device, and overreaching end- point. Perhaps we should have predicted the study outcome based solely on the ubiquitous nature of headache. We did not have a pathologic footprint to track, which remains true to this day. It was known that migraine is an elusive target for phar-
* Corresponding Author:
Mark Reisman, MD
University of Washington Medical Center
Division of Cardiology
1959 NE Paci c Street, Box 356171 Seattle, WA 98195, USA
Tel.: +1 206 598 3171; Fax: +1 206 598 3037; E-Mail: reismanm@uw.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2015 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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