Abstract
We aimed to investigate migraine diagnoses in a hospital setting, use of prescription migraine medicine and levels of serotonin in patients with atrial septal defect. Using Danish national registries to identify all patients born before 1994 diagnosed with atrial septal defect between 1959 and 2013, thus including 2277 patients and a gender and age matched comparison cohort of 22756. Plasma serotonin was measured in 136 patients with a small, unclosed, atrial septal defects and 18 controls. Patients with atrial septal defect had an increased risk of receiving a migraine diagnosis (HR 3.4 (95% CI: 2.6–4.6)) and receiving migraine medicine (HR 1.8 (95% CI: 1.2–2.5)). Ten years after closure, 93% of those using migraine medicine pre-closure, were still receiving this. The risk of having very high plasma serotonin levels was increased in patients with atrial septal defect compared with the control group, but there was no difference in the median values between the two groups. Migraine and use of migraine medicine were increased in atrial septal defect patients. The use of medicine was not diminished by closure of the defect. Plasma serotonin was severely elevated in 18% of the patients with atrial septal defect.
Highlights
Migraine has been widely associated with right-to-left shunts and the incidence in patients with a persistent foramen ovale (PFO)[1] is reported as high as 25–40%2,3
Patients were excluded if the defect was described as a Persistent Foramen Ovale; if the patient had a concomitant congenital heart disease; if the atrial septal defect (ASD) diagnosis could not be confirmed in the hospital record or if the hospital record was lost and not available for validation
We identified 4445 patients with an ASD diagnosed between 1977 and 2013 in the Danish National Patient Registry
Summary
Migraine has been widely associated with right-to-left shunts and the incidence in patients with a persistent foramen ovale (PFO)[1] is reported as high as 25–40%2,3. With shunting through the atria, some of the serotonin rich blood is thought to bypass the liver and the lungs, resulting in theoretically higher levels of plasma serotonin. Serotonin causes both vasodilation and vasoconstriction in different concentrations, and can thereby be among the triggers of a migraine. In patients with an atrial septal defect (ASD)[9], the primary shunt direction is left-to-right. In this study we seek to investigate the burden of migraine in the ASD patients by investigating their risk of hospitalisation with a migraine diagnosis, the use of prescription migraine medicine both before and after closure and the levels of serotonin in patients with an unclosed shunt
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