Percutaneous closure of patent foramen ovale for migraine headaches refractory to medical treatment.
BACKGROUND
Patent foramen ovale (PFO) has been linked to migraine, and several retrospective studies reported an improvement in migraine prevalence or frequency after PFO closure for other reasons, mostly for secondary prevention of paradoxical embolism or following diving accidents. We investigated the outcome of patients undergoing PFO closure solely for migraine headaches refractory to medical treatment.


METHODS
Seventeen patients (age 44 +/- 12 years; 76% female; one atrial septal aneurysm) underwent percutaneous PFO closure using the Amplatzer PFO Occluder (AGA Medical Corporation, Golden Valley, MN). An 18-mm device was used in two patients, a 25-mm device in 13, and a 35-mm device in two. The interventions were solely guided by fluoroscopy, without intraprocedural echocardiography.


RESULTS
All implantation procedures were successful. There were no peri-procedural complications. Contrast transesophageal echocardiography after Valsalva maneuver at 6 months showed complete PFO closure in 16 patients (94%), whereas a minimal residual shunt persisted in one (6%). During 2.7 +/- 1.5 years of follow-up, no deaths and no embolic events occurred. After PFO closure, migraine headaches disappeared in four patients (24%), and improved in eight additional patients (47%). Three patients (18%) reported a decrease of their headaches by 75%, three patients (18%) a decrease of 50%, and two patients (12%) a decrease of 25%, while headaches remained unchanged in five patients (29%). No patient experienced worsening headaches. Moreover, the prevalence of migraine with aura decreased from 82 to 24% (P = 0.002).


CONCLUSIONS
These results suggest that percutaneous PFO closure durably alters the spontaneous course of shunt associated migraine.
Wahl
Andreas
A
Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Praz
Fabien
F
Findling
Oliver
O
Nedeltchev
Krassen
K
Schwerzmann
Markus
M
Tai
Tony
T
Windecker
Stephan
S
Mattle
Heinrich P
HP
Meier
Bernhard
B
D000328:Adult; D006328:Cardiac Catheterization / Q000295:instrumentation; D002560:Cerebrovascular Circulation; D004351:Drug Resistance; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020326:Migraine without Aura / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult