Clopidogrel reduces migraine with aura after transcatheter closure of persistent foramen ovale and atrial septal defects

• Published in: Heart (British Cardiac Society) Vol. 91; no. 9; pp. 1173 - 1175
• Main Authors: Wilmshurst, P T, Nightingale, S, Walsh, K P, Morrison, W L
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01-09-2005; BMJ; BMJ Publishing Group LTD; Copyright 2005 by Heart
• Subjects: Adult; Anticoagulants; Aspirin; Aspirin - therapeutic use; atrial septal defect; Biological and medical sciences; Blood clots; Blood platelets; Cardiac Catheterization; Cardiology. Vascular system; Cardiovascular Medicine; clopidogrel; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Defects; Drug Therapy, Combination; Female; Headaches; Heart; Heart Septal Defects, Atrial - complications; Heart Septal Defects, Atrial - surgery; Humans; Male; Medical Audit; Medical sciences; Middle Aged; Migraine; Migraine with Aura - etiology; Migraine with Aura - prevention & control; Neurology; Patients; persistent foramen ovale; Platelet Aggregation Inhibitors - therapeutic use; Pneumology; Postoperative Care - methods; Postoperative Complications - prevention & control; Respiratory system : syndromes and miscellaneous diseases; Serotonin; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; transcatheter closure; Vascular diseases and vascular malformations of the nervous system; Closure; Persistent fetal circulation; Cardiovascular disease; Intracardiac defect; Phlebology; Vascular disease; Pain; Respiratory failure; Heart disease; Atrial septal defect; Cardiology; Cerebrovascular disease; Nervous system diseases; Respiratory disease; Migraine; Foramen ovale; Congenital disease; Pulmonary hypertension; Cerebral disorder; Newborn diseases; Malformation; Central nervous system disease; Clopidogrel; Circulatory system; Ostium secundum
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2004.047746

Objective: To report the clinical events leading to alteration of an anticoagulation regimen for patients undergoing transcatheter closure of an atrial shunt and how this affected migraine symptoms after the closure procedure. Method: Audit of a change of anticoagulant regimen. Results: In the first few weeks after a closure procedure migraine frequency and severity increased despite treatment with aspirin for six months in 71 patients. Severe attacks of migraine with aura, including status migrainosus, in the first few weeks after transcatheter closure were terminated by addition of clopidogrel to aspirin treatment. Therefore, the anticoagulant regimen was changed with addition of clopidogrel for the first month after the closure procedure (90 procedures in 89 patients). Fewer patients had migraine with aura in the first month after transcatheter closure when taking the combination of clopidogrel and aspirin compared with aspirin alone (11 of 90 (12.2%) v 30 of 71 (42.3%), p < 0.001). Episodes of migraine with aura were more severe and more frequent in patients taking aspirin alone. Conclusion: The combination of clopidogrel for four weeks and aspirin for six months is superior to aspirin alone for six months for preventing migraine with aura after transcatheter closure of an atrial shunt. This beneficial effect of a powerful inhibitor of platelet aggregation suggests that platelets may have a role in pathogenesis of migraine. This may be because of an effect on serotonin stores. Whether clopidogrel has a role in treatment of migraine in other clinical situations requires investigation.