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Migraine with aura following atrial septostomy for pulmonary arterial hypertension

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 55–58 (2007)Cite this article

Abstract

Background A 34-year-old woman with known familial pulmonary arterial hypertension presented with syncope. Despite medical therapy with an endothelin-receptor antagonist and a phosphodiesterase inhibitor, the patient had NYHA class III symptoms, with exertional dyspnea. Right heart catheterization revealed severe pulmonary hypertension (right atrial pressure 15 mmHg, right ventricular pressure 80/15 mmHg, pulmonary artery pressure 80/35 mmHg, mean pulmonary artery pressure 52 mmHg). The patient underwent balloon atrial septostomy, creating a right-to-left shunt. Although she had no history of headaches or migraine attacks, the patient developed a migraine headache with aura on the third day after the procedure. Migraine attacks recurred for the next 2 days, but symptoms were relieved with simple analgesia.

Investigations Physical examination, electrocardiography, laboratory testing, 6-min-walk test, right heart catheterization, chest radiography, transesophageal echocardiography, transthoracic echocardiography.

Diagnosis Migraine with aura following atrial septostomy.

Management Bosentan, sildenafil, furosemide, spironolactone and warfarin therapy, atrial septostomy, and paracetamol therapy for migraine.

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Author information

Authors and Affiliations

  1. MP Rogan is a specialist registrar in the Department of Respiratory Medicine, KP Walsh is a consultant cardiologist in the Department of Cardiology, and SP Gaine is a consultant respiratory physician in the Pulmonary Hypertension Unit, at the Mater Misericordiae University Hospital, Dublin, Ireland.,

    Mark P Rogan, Kevin P Walsh & Sean P Gaine

Authors
  1. Mark P Rogan
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  2. Kevin P Walsh
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  3. Sean P Gaine
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Corresponding author

Correspondence to Sean P Gaine.

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The authors declare no competing financial interests.

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Rogan, M., Walsh, K. & Gaine, S. Migraine with aura following atrial septostomy for pulmonary arterial hypertension. Nat Rev Cardiol 4, 55–58 (2007). https://doi.org/10.1038/ncpcardio0746

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