Migraine and AFib and Flecainide

[Slim2018]

So for the last ten years or so, since the age of 54 I have started getting occasional (ie once or twice a year) migraine auras. Passes within forty minutes max and had an MRI back in 2014. All good. Since my fibrillation started a year ago and taking Flecainide daily (originally 200 mg per day now 100 mg per day) number of aura episodes has gone up significantly, two or three from August 2019 until the end of the year, this year five or six in the last two months. So I am now double jumpy is my heart going out of sinus rhythm and am I going to get zigzag lines across my vision. There is no reason why the number have increased, this week had one Sunday and one Thursday. Even had one about three weeks ago before going over to have a barbecue at, yes my neurologist who is a friend. He is seeing me a week Monday but just wondered if anyone had similar experiences. My cardiologist, who is also a friend (how lucky am I) says that Flecainide can cause headaches and visual disturbances and I do get little tiny flashes or movements at the edge of my vision...views as always gratefully received

[xr1450]

Oh yes, I can relate to this.

I have had proximal AF on and off for around 16 years, used to get it around once a year then a gap of six years with nothing and in the past seven months I've been living an AF nightmare, I'm just about to post on that in a thread of my own if i can figure iut how.

Sorry I digress, these as you call them "migraine auras" I have had them maybe eight to ten times over the years, always starts in my right peripheral vision as a tiny glistening speck and slowly grows bigger and bigger until it just disappears. Reminds me of a kaleidoscope when I was a kid and it's always in a crescent shape as it grows. At first I thought this was in my vision until I put my hand over my eye and it stayed, same if i cover both eyes, painless but worrying none the less. I went to the doctor with this years ago, he sent me to see a neurologist and they gave me a scan and found nothing and put it down to a knock on the right side of my head when I was a kid. I asked if this could be related to my heart condition and the doctor actually laughed and gave me "that" look, you know, the one that says they think your nutz.

So jump forward to 24th June this year two days after my ablation, I get the sparkly lights thing twice in two days (unheard of) and then once more two days later. I was looking for some info about the after effects of ablation and I found a pdf file that is referenced here quite a lot where it talks about the "migraine aura" being a symptom/after effect of ablation (Recovering From Ablation Of Atrial Fibrillation).

Two things, one it seems doctors are wrong about this anomaly being nothing to do with heart/AF conditions and two that it is caused by ablation as we have both experienced this without ablation..

Please excuse the way this is written as I am not very good at expressing myself in words.

[Physalis in reply to xr1450]

Well it isn't exactly caused by ablation but ablation can make it worse. A lot of people get flashes of light etc after an ablation but I had eleven days with an attack of migraine every single day. Not much fun! Because no-one had mentioned this before I even ended up in A&E after five days. The cardiac doctor was very nice to me and afterwards I wondered if he knew more than he said.

After my ablation one of the doctors told me they didn't have to cut through the septum as I had a hole in the heart. This is called a foramen septum ovale. Dr Sanjay Gupta has done a video on it. It's more of a slit than a hole and it comes together when a baby is born and the blood starts circulating to the lungs.

There seems to be a connection between this and migraine. Your experience of previously having migraine and also soon after the ablation is similar to mine. I think it is caused by the slit being opened up to push the catheter through and it takes a bit of time for it to come together again.

Having an opening between the two top chambers of the heart, the atria, means that de-oxygenated blood can go through and mix with the blood that goes through the body. Maybe there is something in that de-oxygenated blood which goes to the brain and can cause an occasional migraine.

I can say that, for me, there is no connection with AFib. I don't know whether red wine, cheese, etc would have made my AFib worse because I'd cut them out already.

[xr1450 in reply to Physalis]

You seem to have misunderstood or I didn't explain properly, their is NO migraine or headache involved, purely the expanding kaleidoscope like sparkling aura that is described as "migraine aura" as it seems people that suffer migraines get this or something like it along with the headache.

This is purely about the lights, also no 'flashing' lights, multicoloured rainbow like sparkling lights.

[Physalis in reply to xr1450]

When I was in hospital a couple of years ago I had migraine and I asked the doctor for something for it. He asked if I had got a headache and when I said no he said it couldn't be migraine.

My migraine attacks usually go like this - first the aura, expanding kaleidoscope describes it perfectly, then it takes about 45 minutes to spread out and disappear. I don't have a headache.

That is not to say that they are all like that, there are some that can make you feel absolutely terrible, I've only had a few of those. After the ablation I had a mixture some with a very nasty headache. Fortunately, nothing for the past two months.

[Physalis in reply to xr1450]

Also from the NHS website "Some people may experience aura followed by only a mild headache or no headache at all."

[KMRobbo in reply to xr1450]

I understood the migraine aura is caused by the hole cut between the atria, and the aura stops when the hole closes up.

[Physalis in reply to KMRobbo]

I think that's right but this foramen septum ovale (hole in the heart) is quite common and I'm assuming mine went back to normal, but still a bit open like it was before, after about a fortnight. I don't know what happens to the hole when they have to drill it, perhaps it just closes naturally. Maybe it isn't very big.

[Buffafly in reply to KMRobbo]

Nope 😐

[KMRobbo in reply to Buffafly]

ncbi.nlm.nih.gov/pmc/articl....

[Physalis in reply to KMRobbo]

Yes, that's very interesting. I can agree with nearly all of that.

The only thing was they say "TsP (Transseptal Puncture) is performed even in patients with a pre-existing patent foramen ovale because it provides favorable access". The EP told me that they didn't have to do a puncture because I had a hole in the heart and I assume that's the PFO.

They also say " The episodes of migraine-like headache in patients undergoing catheter ablation are rarely recognized by both cardiologists and neurologists." I'll definitely tell my cardiologist and ask him to put it on their aftercare leaflet.

[Coco51]

Yes I definitely get this exactly as you describe. No headache - although I do feel a it disorientated for a while after it.

The neurologist I saw said it was called scotoma. I was worried it had been a stroke or TIA as it was quite difficult to see whilst it was going on. But she said loss of vision from a stroke is black, no lights, zig zags etc.

Anyway...It lasts pretty much 20 mins exactly and I get it about two or three times a year. It started 4 years ago after my first ablation. But 30 years ago I had it twice after my daughter was born (hormones?). Then not again till the ablation.

I've noticed that its started a few times when I have bent down quickly, and other times being in - or looking at - bright light or when looking at my phone while sitting in the dark. I think light sensitivity might play a part.

While its going on it is quite difficult to see, although but the vision is still there.

Be interested to hear what your neurolgist has to say. Keep us posted!

[Physalis]

It probably is a bit more complex than that in my case. Mostly I have had ocular migraines and they haven't been much of a problem but I have also had migraines without aura a couple of times which is confusing. That was when I was in hospital and felt really bad, like migraine, but, without the aura, I wasn't sure.

I had one once which lasted for three days and I was vomiting and was ill. Then there were migraines which were so bad I didn't know where to put myself. What can be frightening are the ones where you have one and that goes away and then you have another and even another and by that time your head feels just terrible.

It's important for me not to try and carry on but to go and sit down and eat as much as possible. My thinking there is that it diverts blood from my brain to my stomach.

At first I didn't know what these attacks were. My mother called them bilious attacks. Then one day, this is a very long time ago, I heard the Radio Doctor at ten to eight on something that was like the Today programme talking about migraine. I was pleased to know what it was. My mother, however, wasn't and never really wanted to accept it. I suppose it was because it was something to do with the head.

After the ablation I had several different types of attack, a couple with the headache and, interestingly three which started immediately I had finished a meal. Vagal, I guess!

[CopperSpoon]

I’ve had PAF 15 years - 2 ablations, most recent was two months ago after having a couple episodes of RVR & tachycardia and shocked back into NSR.

All good until 4 days ago when AF occurred out of the blue - and left me in tachycardia once again - avg heart rate 110 (ranges 90-120).

I’ve had brief episodes of the migraine aura following the ablations. TODAY was first time I’ve noticed it otherwise. For a few minutes it was difficult to read - appeared to be the center of my vision initially and then after a few minutes seemed to move to the periphery, then gone within 30 minutes or so.

Hoping everyone has good success living with this mongrel thing! (AF)

Susan Marie

[Buffy-1]

Oh, I love this post. I was diagnosed with AF a year ago, but probably have had it for several years. About 3 years ago I got my first Optical Migraine. I went to the optometrist and gp because I thought I was having a stroke. Came on with severe headache then vision loss and flashing zig zag lights. Now, I have no headache with them. I keep track of what I eat, bright light. I now have 1-2 a month. I find bright light, example, sun light, phone light and tablet can cause an episode. Also floursent the lights. I have a darkening filter on my tablet and phone. I wear double sun glasses on bright sunny days. Mine last 20 minutes. More in my right eye than my left. I have not had an ablation and currently on Pradaxa for a year.

[saulger]

Hi All. What an interesting thread and a new one for me ! Thank you.

I was diagnosed with AFib almost three years ago and the visual aura possibly started around the same time. Never had it previously.

I looked it up and mine matches "scintillating scotoma":

Zig-zag lines that start at one corner and proceed across the eyes. Even with eyes closed:

en.wikipedia.org/wiki/Scint....

In my case the above, and none-aural migraines, can be traced to eating peanuts in the shell.