Objective Closure of patent foramen ovale (PFO) in some cases is associated with resolution of migraine. There are rare case reports of atrial septal defect (ASD)/PFO closure exacerbating migraine in adults. We present the first cases of new onset migraine immediately post-ASD closure in children.

Results Two cases are reported of sudden onset migraine with aura starting shortly after elective ASD repair. The symptoms were severe initially, have decreased in frequency over time but are persistent. One child requires symptomatic relief whereas the other is on prophylaxis. The migraine in one case delayed hospital discharge by 2 days.

Conclusion These are the first reported cases in children of migraine onset post-ASD closure. The aetiology of the link between ASD closure and migraine is unclear; however, causal factors have been linked to the device or to the endothelisation process. Micro emboli formed during endothelisation may embolise provoking migraine. Nickel released during device insertion could exacerbate the cortical spreading depression linked to aura. Neither of these factors explains the persistent migraines in these children.