Closure of Cardiac Right-to-left Shunts May Abolish Migraine

WESTPORT, CT (Reuters Health) – In a subgroup of patients who have severe migraine, closure of a large cardiac right-to-left shunt appears to improve or even eradicate migraine symptomatology.

As reported in the November 11th issue of The Lancet, Dr. Peter T. Wilmshurst, of Royal Shrewsbury Hospital, Shrewsbury, UK, and colleagues interviewed 37 of 40 consecutive patients who had undergone a transcatheter closure of an atrial septal defect or patent foramen ovale.

According to the researchers, the procedure was performed in 29 of the patients in order to permit the resumption of diving after decompression illness, in four it was for suspected paradoxical thromboembolism after stroke, and four it was to close a large atrial septal defect. Twenty-one of the subjects (57%) had a history of migraine before the procedure, including 16 with aura and 5 without aura.

Seven patients who had previously had migraine with aura and three who had previously had migraine without aura reported no migraine symptoms during long-term follow-up, according to the report.

Also, eight subjects who had had migraine with aura before closure reported an improvement in frequency and severity, the authors say. The three other migraine patients reported no change.

Dr. Wilmshurst and colleagues say that their observations suggest that the lungs may “act as a filter for trigger substances in the venous circulation that can initiate an attack of migraine with aura if they reach the brain in sufficiently large amounts.”

Lancet 2000;356:1648-1651.