title: Closure of a patent foramen ovale is associated with a decrease in prevalence of migraine: a prospective observational study.
abstract: BACKGROUND
  A causal relationship between migraine and a right-to-left shunt, due to a patent foramen ovale (PFO), has been suggested. In mainly retrospective studies, percutaneous closure of a PFO has been associated with a decrease in the prevalence of migraine.
  
  
  OBJECTIVE
  In this prospective observational study we evaluated whether percutaneous closure of a PFO is associated with a decrease in the prevalence of migraine.
  
  
  METHODS
  Between November 2003 and August 2005, we included 92 patients (age >16 years) who underwent a percutaneous closure of a symptomatic PFO, which was considered to be related to a paradoxical embolism.They received a headache questionnaire before and six months after closure.Two neurologists diagnosed migraine, according to the International Headache Criteria.
  
  
  RESULTS
  Eighty-nine of 92 patients (97%, mean age 51.6 +/- 12.3 years, 63 men) completed the questionnaire immediately before PFO closure.The overall prevalence of migraine was 27.0%, for migraine without aura (MA-) 15.7%, and for migraine with aura (MA+) 11.2%. After more than six months of follow-up 84 of 89 patients (94%, mean age 52.1 +/- 12.0 years, 60 men) returned the questionnaire. The overall prevalence of migraine in this group decreased from 28.6% to 10.7% (P = 0.001), for MA-from 16.7% to 8.3% (P = 0.07), and for MA+ from 11.9% to 2.4% (P = 0.02).
  
  
  CONCLUSIONS
  Percutaneous PFO closure is related to a decrease in the prevalence of migraine in this prospective observational study. However, randomized placebo controlled trials have to confirm these findings.
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Justin G L M
authors.initials: JG
authors.lastname: Luermans
authors.forename: Martijn C
authors.initials: MC
authors.lastname: Post
authors.forename: Frederik
authors.initials: F
authors.lastname: Temmerman
authors.forename: Vincent
authors.initials: V
authors.lastname: Thijs
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Schonewille
authors.forename: H W Thijs
authors.initials: HW
authors.lastname: Plokker
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Werner I H L
authors.initials: WI
authors.lastname: Budts
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D054092:Foramen Ovale, Patent / Q000601:surgery / Q000628:therapy*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult