AF Association
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Ocular migraines post ablation

12 days post ablation now, feeling great, heart running smoothly and I have been for my first bike ride today.

Pleased as punch.

The only downside thus far has been the 3 ocular (visual) migraines I have had in the last week. I have never had one of these before so it feels logical to assume the ablation is responsible (fried vagus nerve ending causing feedback into the brain, at a guess).

It is, apparently, a known side effect of ablation. Anyone else had these?

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This is a common side effect of ablation explained in our "Recovering From Ablation " booklet (if it is ever published!) It is a result of the transeptal puncture when moving from right to left atria. This normally passes after a couple of weeks.

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Ah that’s brilliant Bob, I didn’t know that was the case. Many thanks.

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You are not alone. Many doctors do not!

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Sure right there Bob, I was told it's from the anesthesia! Told them what I had read and they looked puzzled. I'm 4 days post ablation Mejulie and so far have had 1 migraine. Can't wait to get out and take a walk. Great to hear your doing so well, good luck down the road.

Best wishes, Shaun

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Or forget to tell you.

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hi bob.

i have read ur many post u r really hepling evrerybody..i had psvt problem ,have my rf ablation at avnrt node on july 2017..

after dat i am continuously facing headache,nech ache ,trouble in jogging,gyming..since july frequency of headche reduce still facing many problems..for 4-5 months after ablation i am having high heart rate which is better these days

i read many post nd come to know that everybody is facing problms...what should i do ??what are the reasons asscociated in my case for head pressure ,neck ache etc how to recover ..plz help me out..sorry for poor english

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Sorry Sameer but I am not medically trained, merely very experienced in AF matters. Raised heart rate after ablation is common but I can't offer any advice on your other problems other than to say listen to your body and don't over do things.

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transseptal puncture is also done in psvt cases??

m i feeling headache due to this??

plz advice me one thing whether i see neurologist or electrophysiologist??

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As I said before I am not a doctor so please speak to yours about your headaches.

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thnxx

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I had my ablation just over two weeks ago and had migraines for the 1st week which I’ve never had before. They stopped after the 1st week.

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Snap had 2 or 3 in the first week and then no more

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My first two ablations were carried out under sedation only, for the third I had a general anaesthetic and it was only after this one that I had migraines.

Jean

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Jean I never had migraines after my cancer op and that was even longer than my ablations. Nor after any other GA in the last 73 years. The only ablation when I had them was my third. The first two no problem.

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I've been spared this joy so far, how common is it?

Did you get brain freeze during the ablation? I was warned that the hearts temperature goes down to something crazy (minus 30? I can't remember what he said as it was right at the start of the procedure but I was surprised by how cold), and that I should expect brain freeze like eating an ice cream. It never happened.

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Yes I don’t recall any brain freeze or much of anything tbh! They sedated me heavily (which I think was responsible for me occasionally feeling very ropey the first week of recovery).

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Hi Mejulie69, like you I experienced Migraine Aura after a Radiofrequency ablation last August and only had the last one 3 weeks ago. Granted they are more infrequent but it's now 6 months since the procedure so take every day as it comes. Would be interested to know if anybody else had the Aura long term without the migraine. It's possible I may never get rid of it , though I recently read online that it generally disappears after 1 or 2 years!

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Yes I had migraines after both ablations - but I had them before as well. During my first ablation it was found I had a PVO - small hole in the septrum - so the EP used that instead of punching hole through.

About 20-25% of the population have this mostly benign phenomena and it has been a very well known link to people who suffer migraines for a good many years,

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I found this short article which suggests that migraine and PFO (patent foramen ovale) are linked at a causal, rather than comorbid, level. The evidence from ablation surgery further supports this theory.

americanheadachesociety.org...

I've had migraines for most of my life, so if I have an ablation, I'll ask them to look for a little hole before they make a new one haha!

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The article says the evidence is inconclusive, but I imagine it's likely there have been further stdies since then.

Do you have a separate link for the evidence from ablation surgery?

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I was referring to the anecdotal evidence, whereby patients who were previously migraine-free, suffer with them post ablation.

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Anecdotal evidence may not be scientific but it is often 'spot on'. And could a case be made that much scientific evidence was once anecdotal? Just a thought.

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I had half a dozen in the first couple of weeks after my ablation, then one since in the last five months but ok now. Have had migraines all my life so no problem, just a surprise

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mayoclinic.org/diseases-con...

The terminology is confusing. Are members describing migraine aura or retinal migraine? Were the aura on just one side? How do you distinguish your migraines from simple headaches?

I have never had migraines. At my second ablation 2 weeks ago, I had 3D mapping and assessment of previous LA burns but no ablation, followed by a RA flutter ablation. When I woke from the 5 hour GA, I was confused and had visual hallucinations. I was given precautionary aspirin 300 mgs but CT Head was OK. The anaesthetist later said I had an emergent delirium which lasted a couple of hours and is common.

This thread has made me wonder if post ablation ocular migraine is another explanation.

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I had my ablation in June 2017. I had two ocular migraines two days after my procedure. I’ve never experienced those, very scary! I didn’t have anymore until this month. I had two while at work. I’m hoping I don’t ever experience them again.

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Yes I had this "aura" or ocular migraine symptom twice so far after each ablation. It is like zigzag lines that shimmer as if I've been looking into bright lights. It obscures part of my vision but not all. It is much stronger in one eye than the other and disappears after 20 minutes. No headache. My EP said he had not heard of it, but I did read some research in a medical paper which says it happens in about 0.5% of patients after ablation and usually clears up after the trans septal puncture heals..my GP also said trans septal puncture can cause it.

ncbi.nlm.nih.gov/m/pubmed/1...

A different EP said micro clots might be responsible. Anyway it seems to have stopped now so I hope yours does too. If it comes back I shall ask for further investigations. Glad the heart is behaving! Janet

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My experience of ocular migraines is exactly as you describe!!

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That's interesting to know. Thank you. They were scary! But a neurologist reassured me it was typical ocular migraine, so when the last one happened, which was a while ago, I was out walking the dog and decided to ignore it and it stopped after 20 minutes (All 4 have been 20 minutes)! I can go back for scans if they recur but fingers crossed they haven't. Good luck. J x

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Yep. All mine 20 minutes. Interesting.

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Ah I had that but didnt associate it with aura- now I understand!

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I think more people may get it than EPs suspect. Some patients may not associate these symptoms with their ablation. I see from the paper I linked to that these visual symptoms are called "scintillating scotomas" associated with migraine. Aura seems simpler!

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Interesting abstract. Only 3 of 571 had isolated visual migraine and none of these had headache. Appears to recommend workup for TIA, presumably CT scan.

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That would seem like a sensible idea. This was a small study as you say.

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I had the same thing, about three or four, very shortlived

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I am still getting them and it's been18 months

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How frequently?

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Hi again, in response to the earlier query 're the role of the retina, the migraine aura most of us experience post ablation is classic migraine and is not emanating from the retina but from the brain the cerebral cortex. I had 5 episodes of flashing lights and zigzag patterns lasting 20 minutes each, and an examination by an ophthalmologist revealed that it wasn't from the retina, which was reassuring as flashing lights are associated with a retinal detachment.

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Thank you for replying. Have I understood this right, cortical migraine affects both eyes (as per Mayo clinic article I linked) whereas retinal migraine necessarily involves one eye only? Both can be due to vasospasm or embolus? Post ablation migraine you might expect to be embolic given the nature of the procedure. Not trying to split hairs, just wanting to understand my post op visual hallucinations, which on reflection seem most likely due to the GA. Thanks.

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Hi Oyster, yes a lot of the literature suggests micro emboli may cause the migraine with aura, but let's not forget that one of the main causes may be as Bob said earlier the transseptal puncture and the patent foramen ovale. It's really not clear cut what could be causing it, and one would have reservations about stopping the anticoagulant in such circumstances. I find myself with this predicament as according to a number of sources one may have a greater risk of stroke when aura is present with a migraine rather than having the migraine headache alone.

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Thanks F-M-C-MM

Yes, I understand now that whatever the cause, the important thing is to continue the AC, certainly in the short term and possibly long term if there had been any thought to stop.

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Hi - I had them too and was quite alarmed, thinking that it was a stroke or something. If only I had been told on discharge that this might happen, it would have saved me a lot of angst.

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No one seems worried about them GP EP or cardio or opthamologist

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This is an incredibly interesting thread. Thanks to all. (“Scintillating scotomas “ —oh, brother. )

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Confirming what we already knew.... ncbi.nlm.nih.gov/m/pubmed/2...

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So the question is, now that we know it’s caused by the punctured septum, how do we relieve the migraine? Paraceptemol does not touch it!

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I had my ablation last week and are up to my 7th optical aura migraine no headache thou. I find the only way to get rid of the visual problems is to quickly take 2 panadol with 1 ibuprofen. Thank god I am not getting the headache. But it is very annoying and I want them gone now.

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Just had my 4th ablation and have had ocular migraines for 11 days. Had none after the other three. Thought it was a sinus issue but after reading these posts it may be post surgery. They last about 20 minutes. Some with headache some without. Encouraging that most on this sight eventually go away.

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I had them for about 10 days post ablation but nothing since. I was glad I’d read about the possibility beforehand on the Recovering from Ablation factsheet, so I wasn’t too worried when it happened.

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