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.