title: Is patent foramen ovale closure effective in reducing migraine symptoms? A controlled study.
abstract: OBJECTIVE
  We investigated the prevalence of migraine in patients with patent foramen ovale (PFO), and the effect of PFO closure on migraine symptoms and medications.
  
  
  BACKGROUND
  Studies have shown an association between migraine and PFO. Data have recently suggested a reduction in migraine symptoms following PFO closure. Most of these studies had no controls.
  
  
  METHODS
  Subjects were divided into three groups: No PFO (Controls, n = 65), PFO with no intervention ("Open PFO", n = 63), and PFO treated with percutaneous closure ("Closed PFO", n = 41). We measured the frequency, severity, and impact of migraine on quality of life employing MIDAS scores. Comparisons were made preceding and 90 days after either transesophageal echocardiography (Controls and "Open PFO") or PFO closure ("Closed PFO"). We compared the use of abortive medications between the two time points.
  
  
  RESULTS
  Migraine, especially with aura, was more prevalent in both PFO groups (P < 0.05). Migraine frequency was reduced by 83% in Closed PFO compared with 0% of Open PFO and 10% of control patients (P < 0.0001). Migraine severity and MIDAS scores were reduced by PFO closure when compared to the other two groups (P < 0.0001, P = 0.035 respectively). Reduction in abortive medications was noted in 71% after closure, 5% of Open PFO, and 10% of Controls (P < 0.001).
  
  
  CONCLUSIONS
  In this controlled study, migraine, especially with aura, is more frequent in subjects with PFO. PFO closure is associated with a reduction in migraine frequency and severity, as well as an improvement in MIDAS scores. PFO closure was associated with a significant reduction in the use of abortive medications.
authors.affiliation: Cardiac Catheterization Laboratory, Division of Cardiology, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA. ckimmelstiel@tufts-nemc.org
authors.forename: Carey
authors.initials: C
authors.lastname: Kimmelstiel
authors.forename: Christopher
authors.initials: C
authors.lastname: Gange
authors.forename: David
authors.initials: D
authors.lastname: Thaler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D016022:Case-Control Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D020325:Migraine with Aura / Q000517:prevention & control; D015995:Prevalence; D011788:Quality of Life; D012107:Research Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome