Antithrombotic Therapy to Prevent Migraine Attacks After ASD Closure

Beat J. Meyer, MD reviewing Rodés-Cabau J et al. JAMA 2015 Nov 9.
In a randomized trial, dual antiplatelet therapy was more effective than aspirin alone.

New-onset migraine attacks are reported by about 15% of patients after transcatheter atrial septal defect (ASD) closure. Since migraine attacks are linked to a number of mechanisms (e.g., platelet dysfunction, coagulation disorders, activation of vasoactive substances and inflammatory cytokines), therapeutic approaches have differed. Observational studies have shown a reduction in migraine attacks with dual antiplatelet therapy. Now, Canadian investigators have conducted a randomized trial to assess the effects of clopidogrel plus aspirin after ASD closure. (The study was cofunded by the manufacturers of clopidogrel and the closure device.)

A total of 171 patients (mean age, 49; 62% women) received aspirin (80 mg/day) plus either placebo or clopidogrel (75 mg/day). During the 3 months following ASD closure, the primary efficacy outcome (monthly number of migraine days) was significantly lower with clopidogrel than placebo (mean, 0.4 vs. 1.4). Migraine incidence (9.5% vs. 21.8%) and severity (0% vs. 37% had moderately or severely disabling attacks, as evaluated by the Migraine Disability Assessment questionnaire) were also significantly lower with clopidogrel. Attacks became less frequent over time in both groups. There was one case of transient ischemic attack in the placebo group.

Citation(s):

Rodés-Cabau J et al. Effect of clopidogrel and aspirin vs aspirin alone on migraine headaches after transcatheter atrial septal defect closure: The CANOA randomized clinical trial. JAMA 2015 Nov 9; [e-pub].