Abstract
A 34-year-old woman with known familial pulmonary arterial hypertension presented with syncope. Despite medical therapy with an endothelin-receptor antagonist and a phosphodiesterase inhibitor, the patient had NYHA class III symptoms, with exertional dyspnea. Right heart catheterization revealed severe pulmonary hypertension (right atrial pressure 15 mmHg, right ventricular pressure 80/15 mmHg, pulmonary artery pressure 80/35 mmHg, mean pulmonary artery pressure 52 mmHg). The patient underwent balloon atrial septostomy, creating a right-to-left shunt. Although she had no history of headaches or migraine attacks, the patient developed a migraine headache with aura on the third day after the procedure. Migraine attacks recurred for the next 2 days, but symptoms were relieved with simple analgesia. Physical examination, electrocardiography, laboratory testing, 6-min-walk test, right heart catheterization, chest radiography, transesophageal echocardiography, transthoracic echocardiography. Migraine with aura following atrial septostomy. Bosentan, sildenafil, furosemide, spironolactone and warfarin therapy, atrial septostomy, and paracetamol therapy for migraine.
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