New-Onset of Migraine and Nonmigraine Headache Attacks after Percutaneous Device-Closure of Atrial Septal Defect in Children: A Prospective Multicenter Trial

Objectives: New-onset headaches, mostly migraine attacks (MHA), occurred in 7–19% of adult patients early after transcatheter ASD closure. This multicenter study aimed to evaluate the incidence, timing, duration, possible risk factors for headaches in children after ASD-device-closure.

Methods: A total of 193 pediatric pts after ASD closure from 11 centers in Germany, Austria, and Switzerland were included. After 3+12 months, parents/patients answered a structured questionnaire concerning headache episodes before and after ASD closure. A pediatric neurologist actively participated in the design and evaluation process of the questionnaire. Data were then related to patient and implantation specifics and analyzed respectively.

Results: From 11/2012 to 12/2014, a total of 193 patients, mean age 7.24 (0.7–17) years and body weight 27.9 (8.1–96) kg, received an ASD-device-closure. 66% were female. Primarily the Amplatzer-Septal-Occluder (n = 113) and the Gore-Septal-Occluder (n = 34) were implanted. All patients received oral ASS for 6 months. 39pts (19%) reported about occasional/frequent headaches before intervention, which also occurred in most of them after intervention with an unchanged frequency. New-onset headaches were reported in 28 patients (18.6%), mostly within the first 4weeks (78.5%). Only five patients (17.9%) fulfilled criteria for Migraine headache. Initially, headache attacks occurred one to two times per week, pain intensity was described as moderate by 71.4% of patients. Multivariate analysis revealed no correlation of MHA and nonmigraine headaches (NMHA) to device type or size, and to age or body weight. Female sex (p = 0.028) and residual shunt (p = 0.01) were the only predictors of MHA/NMHA occurrence. Residual shunts were small/trivial (1–2 mm) and were found on echo immediately after closure in 9.4%, after one week in 6.8%, after one year in 3.6%. Twelve months after intervention headaches persisted in only 21% of pts with a reduced intensity.

Conclusion: New-onset headaches after ASD-device closure are a frequent finding in children (18.6%). Predominantly these are, in contrast to adult pts, NMHA. They occur within the first 4 weeks after intervention. Mostly they have a benign course dissolving within the next months. Female sex and residual shunt were the only positive predictors of postinterventional headaches. As residual shunts were trivial and closed spontaneously in nearly all of the pts and device characteristics did not correlate with headache occurrence, mechanism of this phenomenon is not completely understood.