If you’ve ever experienced a migraine, you know it’s no laughing matter. But for people with Atrial Septal Defect (ASD), relief is possible thanks to an Israeli study which shows that correction of the ASD relieves the intensity and frequency of the migraines.
ASD is one of the simplest forms of congenital heart disease, and one that can be repaired surgically. Present in 4 out of 100,000 people, ASD is a hole in the wall between the two upper chambers of the heart.
Normally, blood entering the right side of the heart stays on the right side (this is low oxygen blood), and blood on the left side of the heart stays on the left side (this is oxygen rich blood) which is then pumped to the body. When a defect or “hole” is present between the atria (or upper chambers), some oxygen rich blood leaks back to the right side of the heart. It then goes back to the lungs even though it is already rich in oxygen. Because of this, there is a significant increase in the blood that goes to the lungs. Over the course of several years, this may impair the function of both the heart and the lungs, resulting in a markedly foreshortened life expectancy.
One of the many side effects of ASD is migraines – over 50% of ASD sufferers also regularly experiencing migraines. In general, 28 million Americans suffer from migraines, sometimes characterized as a ‘sick headache.’ It is a one-sided headache that has either loss of appetite, nausea, or vomiting accompanying it, as well as having the head pain and the neurological signs, which may accompany many of the attacks.
They can last anywhere from a few hours to a few days. Some people have them weekly, others have fewer than one a year. Migraines usually begin sometime between the teen years and the age of 40.
Researchers at the Rabin Medical Center led by Dr. Arieh Koritzky, the head of the Headache Department and Dr. Alexei Yankovsky the assistant head of the Neurological department, conducted a study on 227 patients with ASD.
They analyzed the frequency and clinical features of migraine in the patients, and reported that 39 patients had migraines with aura, and 28 patients had migraine without aura, a ratio that is usually reversed in the general population. Thirty-seven patients had other headaches.
Migraine aura without headache (formerly called migraine equivalent or acephalic migraine) refers to visual, neurologic, or gastrointestinal symptoms occurring transiently and without the headache. These symptoms occur in persons who have had previous migraines, or who have a family history of migraine. In some cases, they can also occur in people who have never had migraines.
Seventy-two of all the patients tested underwent ASD repair. Of these, 70% of those with migraines improved after the ASD closure, while in the non-migraine group, 37% improved.
“On many occasions, improvement [in the migraine group] was dramatic and expressed in sudden and complete cessation of headache or improvement in aura and associated symptoms,” Yankovsky reported.
He speculated that possible causes for these findings might be:
** A genetic defect with common phenotype for migraine with aura and ASD.
** Paradoxical emboli cessation
** Atrial natriuretic factor may be involved in migraine process, since expression of it was found in animal models of migraine with aura.
** Disbalance of atrial pressure
Currently the researchers are checking if there’s a genetic connection between the two occurrences, or if there’s hormonal imbalance among ADS sufferers that causes the migraines.
“It’s worthwhile when someone is experiencing severe migraines to clarify if the patient suffers from ADS. Efficient treatment of the ADS can in many cases cause the headaches to cease,” summed up Koritzky. The study by the Israeli researchers was reported in The Journal of Head and Face Pain. A report of the study was also presented at the International Conference on Headaches that took place in Rome late last year.