Andrea Natale, MD - Guest Contributor
Migraine, a neurovascular disorder affecting more than 29.5 million Americans, is characterized
by recurrent attacks of incapacitating headache associated with extreme sensitivity to light
and sound, nausea and vomiting. Although the cause and triggers of migraine is not fully
understood yet, it has been widely accepted as being caused by dilatation of blood vessels in
the brain, abnormal firings from unusually excitable brain nerve cells and/or inflammation of
the meninges.
Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice.
It is characterized by chaotic and uncoordinated contractions of upper chambers of the
heart (atria) giving rise to an irregular and rapid heart rate. Treatment goals include restoring
the heart to normal rhythm, slowing the heart rate and preventing blood clot formation.
Antiarrhythmic drugs and radiofrequency catheter ablation (RFCA) are the mainstay of therapy
for AF, RFCA being considered as the treatment of choice in drug-refractory AF patients.
Atrial septal defects (ASD), including patent foramen ovale (a condition with a defect in the wall
between the two atria); have been linked to an increased prevalence of migraine headaches
in the general population. During catheter ablation, the wall between right and left heart
is routinely perforated (a procedure called trans-septal puncture or TSP) to gain access to
the left heart. TSP causes an iatrogenic atrial septal defect (ASD) with a transient right-to-
left shunt which can predispose patients to stroke and migraine. In two different studies,
with 571 and 183 patients in whom TSP was performed, the incidence of migraine was 0.5%
and 2.2% respectively and the migraine was transient and resolved without any sequelae. In
separate studies, complete resolution or improvement of migraine was noticed with the ASD
closure. Additional case-studies have also reported incidence of AF occurring during episodes of
migraine with aura while the cardiac rhythm was normal in the absence of migraine.
All these reports evidently demonstrate an association between AF, TSP during RFCA and
migraine, but fail to clearly define the nature of it. Additionally, very little is known about the
impact of catheter ablation (for AF) on the natural course of pre-existing or newly-occurring
migraine.
Texas Cardiac Arrhythmia Institute (TCAI) and NeuroTexas Institute (NTI) at St. David’s
HealthCare are collaboratively conducting a prospective study to explore;
- - the nature of association between AF and migraine
- - if catheter ablation influences the incidence and clinical course of migraine in patients with
or without a previous migraine history
- - effect of catheter ablation on migraine status of AF patients with or without comorbidities
such as hypertension, diabetes, obesity, high cholesterol, and respiratory diseases like asthma
and chronic obstructive pulmonary disease
- - association of migraine with any specific type of AF; namely paroxysmal, persistent or long-
standing persistent
- - impact of therapeutic Coumadin, a blood-thinner which is routinely used during RFCA, on
the prevalence and clinical course of migraine
Information obtained from this study will provide insight into a better understanding of the nature
of relationship of AF with migraine; which would be useful in efficient risk-stratification and patient
management.
