Association of Ventricular Tachycardia Episodes and ICD Shock Therapy With Probable Migraine in Patients With Implantable Cardioverter-Defibrillators

Objective: Probable migraine is a common neurological condition that may adversely affect quality of life, particularly in patients with cardiovascular disease. Ventricular tachycardia (VT) and implantable cardioverter-defibrillator (ICD) shock therapy may cause transient cerebral hypoperfusion, a mechanism implicated in migraine pathophysiology. This study aimed to investigate the association between VT episodes, ICD shock therapy, and probable migraine in patients with ICDs.
Method: This retrospective, single-center study included 200 patients aged ≥18 years who reported headaches and had undergone implantation of a single- or dual-chamber ICD or a cardiac resynchronization therapy defibrillator (CRT-D). During routine device follow-up, patients completed a questionnaire based on the 2018 International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. The questionnaire was used to identify probable migraine, and patients meeting the criteria were referred for neurological evaluation. Device interrogation data were reviewed for ventricular arrhythmias and ICD shock therapy. Clinical, demographic, echocardiographic, and device-related characteristics were compared between patients with and without probable migraine.
Results: The mean age of the study population was 63.6±12.9 years, and 36.5% were female. Probable migraine was identified in 50 of 200 patients (25.0%). Ventricular tachycardia was documented in 107 patients (53.5%), and 44 patients (22.0%) received ICD shock therapy. VT was significantly more frequent in patients with probable migraine than in those without probable migraine (66.0% vs. 49.3%, P = 0.041). Probable migraine was also more prevalent among patients who received ICD shock therapy than among those who did not (40.9% vs. 20.5%, P = 0.006).
Conclusion: VT episodes and ICD shock therapy were associated with a higher prevalence of probable migraine in patients with ICDs. These findings suggest a possible relationship between ventricular tachycardia, ICD shock therapy, and probable migraine. The proposed role of cerebral hypoperfusion remains hypothetical and requires further investigation.

Keywords: Cerebral hypoperfusion, ICD shock therapy, implantable cardioverter-defibrillator, probable migraine, ventricular tachycardia.