Wei SH et al. – Bigger atrial septal defect (ASD) size and lower plasma calcitonin gene–related peptide (CGRP) levels before closure can be a potential predictor of new–onset MHAs. Furthermore, a significant increase of CGRP levels during migraine attack implies that the occurrences of new–onset MHAs after ASD closure correlate with the release of CGRP. This suggests CGRP sensitization from a lower baseline may be involved in the occurrence of new–onset MHAs after ASD closure.

• Authors prospectively collected patients before and after closure and measured plasma CGRP levels using enzyme–linked immunosorbent assay.
• Forty atrial septal defect (ASD) patients who had no migraine previously were enrolled.
• Four (23.5%) of the 17 consecutive patients whose CGRP levels were checked before ASD closure had new–onset MHAs.

• The patients with MHAs had bigger ASD size (20 ± 0.9 vs 16 ± 1 mm, P = .009) and lower CGRP levels before closure (21.1 ± 3.9 vs 90.1 ± 27.1 pg/mL, P = .042) than those without.
• Among the 5 patients with blood samplings both during and between attacks, a paired comparison revealed a significantly increased level during attack (257.2 ± 45.5 vs 45.6 ± 25.5 pg/mL, P = .03).