Prevalence of Atrial Septal Aneurysm in Patients With Migraine and Patent Foramen Ovale Associated With Ischemic Stroke

David Bai, PharmD

Patients with migraine, patent foramen ovale (PFO), and atrial septal aneurysm (ASA) have more frequent ischemic brain lesions, migraine with aura, and larger PFO sizes than patients with migraines and PFO without ASA, according to the results of a recent study.

PFO is an interatrial opening that did not close up during infancy, and although the occurrence of PFO is not rare in the general population (27%), its prevalence is nearly doubled in patients with migraine with aura (48%). ASA is another heart deformity where the atrial septum bulges into the right or left atrium. The prevalence of ASA is rare (2%-3%) but occurs significantly more frequently in the presence of PFO.

Although the effects of ASA are not fully understood, its incidence has been identified as one of the risk factors for cryptogenic stroke. Because patients with migraine are more predisposed to PFO, their risk of ASA also increases. To analyze this connection further, researchers conducted a retrospective study on patients with migraine and PFO and its association with ASA.

In this study, patients with migraine and PFO were divided into 2 groups: group A for patients with ASA and group B for patients without ASA. Baseline characteristics were similar between the 2 groups; however, patients in group A had increased frequency of ischemic brain lesions (11.3% vs 6.2%, P = .038), migraines with aura (32.5% vs 21.1%, P = .040), and significantly larger PFO size (median size; 2.6 mm vs 2.1 mm, P = .007).

All patients underwent PFO closure either through Cardi-O-Fix PFO occluder or Amplatzer PFO occluder. The procedure was successful in all the patients, with no patients experiencing transient ischemic attacks or stroke afterward. Two patients did develop paroxysmal atrial fibrillation: 1 reverted spontaneously and 1underwent pharmacological conversion.

To analyze the differences in migraine severity, investigators used the headache impact test-6 (HIT-6). Prior to surgery, baseline HIT-6 scores were 61 and 63 for groups A and B, respectively. At the 1-year follow up, the average HIT-6 scores were 36 were both groups, indicating a drastic decrease from baseline. No significant differences before and at the 1-year follow up after the PFO closure were seen between the 2 groups. 

Based on the findings, investigators concluded that the prevalence of ASA in patients with migraines and PFO is associated with silent stroke, larger PFO size, and migraines with aura. However, due to similar HIT-6 scores between the 2 groups, there does not seem to be differences in the severity of the migraines.

He L, Cheng G, Du Y, Zhang Y. Clinical relevance of atrial septal aneurysm and patent foramen ovale with migraine. World J Clin Cases. 2018;6(15):916-921. doi: 10.12998/wjcc.v6.i15.916.
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