Discussion
We presented a case of a girl with a history of POTS who had chronic
migraine. ASD closure dramatically relieved her prolonged headaches. As
the active standing test results were the same before and after ASD
closure, we concluded that the improvement in interatrial structure
contributed to relief of migraine.
A systematic review of case-control studies on migraine and patent
foramen ovale (PFO) has shown an apparent bidirectional
association.1 Another prospective observational study
of headache in patients with ASD has confirmed the high prevalence of
headache, particularly migraine, in ASD patients.2Microemboli and vasoactive chemicals such as serotonin from
interatrial communication and
transient changes in oxygen concentration have been assumed as causes of
migraine.1, 3 Many observational studies have reported
improvement in migraine headaches in 65%-91% of patients after PFO
closure.3 Although three recent randomized controlled
trials failed to show the efficacy of PFO closure in reducing more than
50% of migraine headaches, subgroup analyses of migraine with aura
showed statistically superior benefits.4-6 By
contrast, very few studies have examined the association between ASD
closure and migraine. This may be because ASD is relatively rare
(1.2–3.0 cases per 10,000 births) compared to PFO.7One study of 25 patients with ASD showed that there was no statistically
significant difference in the frequency and duration of
headaches.2 ASD closure currently does not take
precedence over pharmacotherapy in treating migraine. However, our
patient clinically responded better to ASD closure than to
pharmacotherapy as migraine headache treatment. Our
findings indicate that there may
be a subgroup of migraine patients who benefit from ASD closure. Further
systematic case-control studies will be required to clarify the
association between ASD closure and migraine.