The frequency of headache and migraine in the children patients having congenital heart disease with left to right shunt

Introduction and Objective: Headache is one of the common complaints of the childhood age group and it occurs due to effects of various causes on the pain sensitive formations which are found within or outside the skull. Headache is a serious health problem that affects attendance and school performance of school-age children significantly. The effect level of headache on school success, memory, personality, interpersonal relationships and attendance depends on the etiology, frequency and severity of headache. The etiological causes of headache include also congenital heart diseases. It is known that the most common cause of headache in childhood is migraine. The most common type of migraine is migraine without aura. In recent years, the studies on adults have shown a close association between the frequency of right-to-left shunt and migraine disease, especially migraine with aura, but the data are inadequate. Although predominantly left-to-right shunt is present in the patients with acyanotic heart disease, bi-directional flow is present. The prevalence of migraine is also high in these patients. Therefore, the relationship between migraine and acyanotic heart disease has also become an issue of interest. There is also a limited number of studies in the literature which investigate this topic in childhood. In some studies, the prevalence of migraine reduced by percutaneous closure of the shunt from left to right, but there was no initial reduction in some cases, however, a significant decrease was observed in prospective follow-up. In some of the studies, newly diagnosed migraine patients developed in some cases, the characteristic of migraine changed and transition from migraine with aura to migraine without aura was observed. In our study, it was aimed to determine the association of acyanotic congenital heart disease with headache and migraine in childhood age group, to evaluate whether there would be a decrease in the prevalence of headache and migraine after percutaneous closure of the defect and to determine the prevalence of migraine with and without aura and to investigate its association with congenital heart disease. Materials and Methods: The study was carried out prospectively on 58 patients (23 female, 35 male) who met the including criteria of the study among the patients who were diagnosed with congenital heart disease with left-to-right shunt in Gaziantep University Faculty of Medicine, Department of Pediatric Cardiology and for whom the repair procedure was planned via the survey which was prepared by Gaziantep University Medical Faculty Pediatric Neurology Clinic according to ICHD-3 criteria. ninth months by reaching again the patient and the relatives of the patient. Findings: According to the results of the survey which was conducted before the repair procedure on the patients which met the inclusion criteria for the study, out of 58 patients, 11 (19%) had headache. There was statistically significant difference between those with headache and those without headache (p = 0.001). The rate of those with headache at onset was found to be significantly lower (p <0.05). The etiologic cause was due to migraine in 9 of 11 patients (p = 0,001) in whom headache was detected among the patients with congenital heart disease with left-toright shunt before the repair procedure and it was significantly lower (p <0,05). After the repair procedure, four the patients could not be reached at the third month. According to the new results of the survey on the remaining 54 patients; it was detected that three patients did not have headache after the procedure. The headache of these three patients before the repair procedure was of migraine origin. No significant difference was found between the headache at onset and the headache at the third month. After the repair procedure at the sixth month and ninth month, the survey was repeated by calling the patients on the phone, but there was no change in headache. No significant difference was detected between the headache at onset and the headache at the sixth and ninth months. There was no significant difference between the presence of headache at the third month and presence of headache in the sixth and ninth months. Before the repair procedure, there were nine patients in whom the etiological cause was attributed to migraine were found, and one patient (11.1%) had migraine with aura. In the follow-ups at the third, sixth and ninth months, among the remaining six patients with migraine, migraine with aura was detected in the same patient. The other five patients had the clinic of migraine without aura. When the migraine attack frequency before the procedure was compared at the third month, there was a decrease in the migraine attack frequency in two patients and no change in four patients. The frequency of migraine attacks did not change in the migraine patients with aura. There was no statistically significant difference between the first measurement and the third month, sixth month and ninth month measurements in terms of migraine attack frequency (p = 0,055). Of 58 patients who participated in the study, the closure procedure of ASD was performed in 31(53.4%) patients, VSD closure in 15 (25.8%) patients and PDA closure in 12 (20.6%) patients. According to the result of the survey that was conducted before the procedure, of 11 patients with headache, seven (63.6%) had ASD type, two (18.2%) patients had VSD type and two patients (18.2%) had PDA type of shunt. There was no significant difference between the headache at onset and shunt type (p = 0.462). Three different devices, namely, Amplatzer ®, Lifetech ® and Occlutech ®; were used in the patients. Their rate of use were as following; amplatzer in 38.1%, llifetech in 45.2% and occlutech in16.7% of the patients. When examining the relationship between the brand of used device to seal the shunt and the headache, no significant difference was found. Conclusion: In our study, the presence of headache which was detected before closure via transcatheter in the congenital heart disease patients with left-to-right shunt and the relationship of this pain to migraine was found to be statistically significant. Although reduction was observed in the frequency and severity after the procedure, also in the attack number of migraine patients, it was not found to be statistically significant. The studies to be carried out on the causative relation between migraine headache development and left-right shunt will reveal new information regarding the clinic and treatment of migraine. Key words: headache, childhood, migraine, left-to-right shunt.