Improvement of migraine after patent foramen ovale percutaneous closure in patients with subclinical brain lesions: a case-control study.
OBJECTIVE
We sought to evaluate the benefits on frequency and severity of migraine recurrence after patent foramen ovale (PFO) closure in patients with subclinical brain lesions at magnetic resonance imaging (MRI).


BACKGROUND
Migraine improvement has been reported after PFO closure in patients with cerebrovascular symptomatic events. Subclinical brain MRI lesions are detectable in patients with PFO and in migraineurs.


METHODS
A total of 82 patients with moderate/severe migraine, PFO, large right-to-left shunt, and subclinical brain MRI lesions were prospectively examined for a 6-month period. Patients were subdivided into closure (n = 53) and control (n = 29) group according to their consent to undergo percutaneous PFO closure. In controls, therapy for migraine was optimized. Six-month frequency and severity of migraine recurrence were compared with baseline.


RESULTS
The number of total attacks decreased more in the closure group (32 +/- 9 to 7 +/- 7, p < 0.001) than in the control group (36 +/- 13 to 30 +/- 21, p = NS) (p < 0.001). A significant reduction in disabling attacks was observed only in the closure group (20 +/- 12 to 2 +/- 2, p < 0.001; controls: 15 +/- 12 to 12 +/- 12, p = NS). Migraine disappeared in 34% of the closure group patients and 7% of controls (p = 0.007); >50% reduction of attacks was reported by 87% and 21%, respectively (p < 0.001). Disabling attacks disappeared in 53% of closure group patients and 7% of controls (p < 0.001); >50% reduction occurred in 89% and 17%, respectively (p < 0.001).


CONCLUSIONS
In migraineurs with a large PFO and subclinical brain MRI lesions, a significant reduction in frequency and severity of migraine recurrence can be obtained by PFO closure when compared with frequency and severity in controls.
Vigna
Carlo
C
Department of Cardiology, Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo, Italy. carlovigna@libero.it
Marchese
Nicola
N
Inchingolo
Vincenzo
V
Giannatempo
Giuseppe Maria
GM
Pacilli
Michele Antonio
MA
Di Viesti
Pietro
P
Impagliatelli
Matteo
M
Natali
Rosaria
R
Russo
Aldo
A
Fanelli
Raffaele
R
Loperfido
Francesco
F
D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D001927:Brain Diseases / Q000175:diagnosis / Q000503:physiopathology*; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008881:Migraine Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D014463:Ultrasonography