Migraine headache relief after percutaneous transcatheter closure of interatrial communications.
BACKGROUND
Migraine headache (MHA) is present in 12% of adults, but has been reported to have a higher prevalence in patients with presumed paradoxical embolism and patent foramen ovale. PFO closure in these patients has been reported to improve migraine, but follow-up periods in previous studies have been relatively short and concomitant medical therapy as well as placebo effects might have influenced the results. This study investigated the long term course of MHA in a large cohort of patients after closure of PFO well beyond the initial phase of concomitant antiplatelet medication.


METHODS
191 consecutive patients with presumed paradoxical embolism underwent percutaneous transcatheter closure of patent interatrial communications for prevention of recurrent thromboembolism. We report the course of MHA before and after closure.


RESULTS
Before the procedure, MHA was present in 24% of patients. At a mean follow-up of 38 months (range 6 to 82) after the procedure MHA had disappeared completely in 24% of patients, and in another 63% symptoms had improved. At a mean duration of follow-up of 38 months a significant reduction (p < 0.000) of number, intensity, duration of episodes, and in the number of accompanying symptoms during an MHA episode was found.


CONCLUSIONS
Percutaneous transcatheter closure of patent interatrial communications results in significant amelioration of MHA in 87% of patients (complete resolution in 24% and significant improvement in symptoms in 63%). Ongoing randomized trials and larger epidemiologic surveys need to further elucidate the role of device therapy for MHA.
Dubiel
Mark
M
Department of Internal Medicine, UKB, Academic Teaching Hospital, Charité Medical School, Humboldt University, Berlin, Germany.
Bruch
Leonhard
L
Schmehl
Ingo
I
Liebner
Matthias
M
Winkelmann
Anne
A
Stretz
Anna
A
Grad
Marc Oliver
MO
Kleber
Franz Xaver
FX
D000368:Aged; D006328:Cardiac Catheterization; D019320:Embolism, Paradoxical / Q000601:surgery / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D015995:Prevalence; D012189:Retrospective Studies; D055502:Secondary Prevention; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome