Atrial septal defect migraine


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Research suggests that some atrial septal defect patients may develop a comorbidity complex involving migraines. While there is no direct link to migraines and atrial septal defects, research has noted that treatment 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 successfully influenced reduction in migraine instance and overall morbidity of atrial septal defect symptoms.

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. 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).

Medical therapy for migraines
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.

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