Migraine post ablation

Is it common to experience morning headaches after an ablation? What does it mean and how long do they last?
Also my resting heart rate has gradually gone up, now 76ppm.



Edited 1 time(s). Last edit at 01/28/2023 04:37PM by colindo.

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colindo
Also my resting heart rate has gradually gone up, now 76 bpm.

Very common after ablations. This can last a year or more.

I can't answer your first question with any personal experience or reading, but I have briefly considered a possibility. I'll explain, with a bit of personal history:

I have known about my sleep apnea since being diagnosed after a polysomnography a few months after developing AF. It was the very last test offered by my cardiologist, and it produced the 'Bingo!' Four years later, I had an angiogram to check me out for ischemic heart disease. It is a catheter insertion procedure much the same as for an ablation, just two different insertion points. Starting the first night after the angiogram, and then again four months later when I finally got the ablation, I began to have 'sleep onset central apnea' events. I would get several of them before I finally fell asleep. These went away, both episodes, within about six-eight days.

I tell you this because our bodies react to intrusions and stressors, even if those things seem innocuous or relatively straightforward at the time. Our sleep changes a bit. We've had narcotics and/or system depressants in the way of anesthetics. We sleep oriented differently if we have an incision that needs to be left alone and not slept on. All these and other factors can affect our general health and how we sleep.

I wouldn't be surprised if this goes away in time, even if it takes several long weeks or months the way our heart rates take a long time to return to normal heart rhythm or rates. But, it wouldn't hurt to put the question to an anesthetist, or at least to your GP, to see if anyone else reports this in the literature.

[www.ncbi.nlm.nih.gov]

Abstract
Catheter ablation for atrial fibrillation creates an iatrogenic atrial septal defect by transseptal puncture, which may produce a transient right-to-left shunt. We encountered a 44-year-old man who presented with de novo migraine-like headache after cryoballoon ablation for atrial fibrillation. On reviewing the literature, we found additional cases in which migraine-like headache occurred within one week after the procedure and spontaneously within three months. We should recognize migraine-like headache as a potential complication of catheter ablation.

I think that if you search the site you will find that a number of us have had this--either just the aura or the aura and the headache. It seems to be associated (as GeorgeN indicated) with the transceptal puncture. I had auras every day after such a puncture when I had a MitraClip inserted and have had them again after my recent ablation. In the first instance they diminished in frequency as the puncture healed. I am still getting migraine-like headaches many weeks after my recent ablation--though they are less frequent. It seems that time is the cure for those of us that get them. Some EPs do recognize this phenomenon though I don't think that there is consensus on why this happens for some patients.

Thanks, George, for capturing that reference.

Thanks GeorgeN and other posters for your help.
It seems it's a rare post ablation condition, thankfully I have no headache today. Hopefully that's the end of it.

Thanks, Colindo, for asking that question! I had a major migraine attack the day after my first and only ablation two years ago. For the next three or four days I had light migraines or auras, and then never again. I always wondered whether this was a coincidence, but could not see how these two things, ablation and migraine, could be connected. (Now I still don't really know what a "iatronic atrial septal defect" or a "right-to-left shunt" are, but they seem to be a temporary minor injury incurred during ablation.) Should I ever have one again, I will be prepared for that possibility.

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Bibi
(Now I still don't really know what a "iatrogenic atrial septal defect" or a "right-to-left shunt" are, but they seem to be a temporary minor injury incurred during ablation.) Should I ever have one again, I will be prepared for that possibility.

Iatrogenic means caused by a medical exam or procedure.

Atrial septal defect is a hole in the wall (septum) that divides the atria of the heart. Septal defects can also be congenital. In the case of ablations, are an intentional part of the procedure. [www.childrenscolorado.org]

Right to left atrial shunt occurs when right atrial pressure is higher than left atrial pressure. This can be observed in patients with pulmonary hypertension, right ventricular dysfunction, or diminished right ventricular compliance. Hence flow is going the direction it is not supposed to, but appears to be temporary after ablations. [www.ncbi.nlm.nih.gov].

Thanks for the detailed explanation in ordinary language, GeorgeN. Much appreciated!

Yes, you can search my old posts. Mine came on the week after my 1st ablation, I was never a headache guy before. I thought I was having a stroke. Sadly they never went away and only got worse having 1 to 3 migraines a month with full visual aura for 4 years.

But wait, after many MRI's, neuros and every migraine drug doing nothing one neuro suggested Propranolol. We did a little trial at 20 mg a day and they almost went away, then we upped to a 60mg extended release and boom, they have stayed away. No visual auras anymore and any little headache is very minor now.

Has the added benefit of keeping my HR lower which ever since my 4th ablation (1st Natale) never really settle low and I spent too much time in the 90's with easy spikes. Now I spend most of my time around a perfect 70 so it's been a great drug on multiple fronts for me cutting down PAC's as well.

Theories abound as to why this happens and you are not the first. EP's tend to look at you like you are crazy if you mention it to them so not much help there. Good luck.



Edited 1 time(s). Last edit at 02/08/2023 10:08PM by Fibrillator.

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Fibrillator
one neuro suggested Propranolol.

I just read that propranolol is different from most Beta Blockers in that it crosses the blood-brain barrier. Maybe this is why they chose it for you. Glad it has made such a difference.

Similar to my first failed ablation doctor also sad how many doctors I went thru before one said, hey, why don't we try this. Thousands in testing and imaging, try this latest greatest migraine drug, try this anti depressant and on and on. Then one says, how bout this old cheap Beta Blocker, it's what works best with my patients.

I am like why is the 1st I am hearing of this! But whatever, be diligent and don't let them tell you to suck it up. So many things have left me so skeptical of the entire medical system.

Sufficed to say I view this Neuro in high regard like I do Natale. They are the only two doctors who when I faced them with a challenge others could not solve, they did. That makes them "above" and the lens of how I view quote "good" doctors now. Are you doing anything else someone else is not.

I digress, rant off ;-)


For me Propranolol seems to have stopped the migraines dead in their tracks after years of losing a week a month of my life to them. Smoothed out PAC's, PVC's, lowered my HR to a more overall comfortable including in stressful situations it is a win. If there are side effects, they are not noticeable.

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GeorgeN

(Now I still don't really know what a "iatrogenic atrial septal defect" or a "right-to-left shunt" are, but they seem to be a temporary minor injury incurred during ablation.) Should I ever have one again, I will be prepared for that possibility.

Iatrogenic means caused by a medical exam or procedure.

Atrial septal defect is a hole in the wall (septum) that divides the atria of the heart. Septal defects can also be congenital. In the case of ablations, are an intentional part of the procedure. [www.childrenscolorado.org]

Right to left atrial shunt occurs when right atrial pressure is higher than left atrial pressure. This can be observed in patients with pulmonary hypertension, right ventricular dysfunction, or diminished right ventricular compliance. Hence flow is going the direction it is not supposed to, but appears to be temporary after ablations. [www.ncbi.nlm.nih.gov].

Iatrogenic is my most vocabulary word. After over 20 surgeries, my medical records are full of sentences that started with “caused by iatrogenic”

Great useful info! Thank you all for posting it.

I relate to the posts about doctors giving up when they don't know the solution and don't take the initiative to try to solve the problem or help you. I'm experiencing that completely. I voiced at a recent ER visit at Mayo (known for solving difficult medical problems) that the cardiologists/EPs there give up as soon as the problem gets difficult and act like there is nothing wrong because they can't easily figure it out. This is known as medical gaslighting. I've seen it many times over the years. Many people suffer because of it.

I'm happy to be in the Natale loop thanks to you all. He's currently reviewing my case and I'm waiting for an appointment. I look forward to working with a doctor who doesn't give up on difficult problems.

"Medical gaslighting happens when healthcare providers dismiss, explain away, or don’t believe a patient’s symptoms. While this can happen to anyone, it’s especially common for women, and those struggling with invisible illnesses like migraine. It’s a dangerous practice that often results in misdiagnosis and/or the inability to receive appropriate and timely treatment and care."

[www.migrainemeanderings.com]