title: Is it too early to recommend patent foramen ovale closure for all patients who suffer from migraine? A single-centre study.
abstract: OBJECTIVE
  To evaluate the course of migraine in migraine headache patients undergoing patent foramen ovale (PFO) transcatheter closure.
  
  
  BACKGROUND
  Migraine has an important impact on the quality of life, and it seems to be one of the most disabling medical illnesses. In several studies, a high prevalence of right-to-left shunt has been described in patients with migraine, especially migraine with aura. The presence of right-to-left shunt, whatever the mechanism, may be the most potent trigger of migraine attacks in both migraine with aura and migraine without aura and the main determinant of aura in migraine with aura.
  
  
  METHODS
  A cohort of 42 patients (nine men/33 women; mean age 39 +/- 11.2 years), current migraineurs, underwent PFO percutaneous closure in our centre between January 2004 and December 2007. All patients rated the severity of their migraine preoperatively and 6 months postoperatively, indicating the frequency, duration, and intensity of the attacks and the occurrence of the aura in the prodromal phase, during the past 6 months, according to the migraine severity score.
  
  
  RESULTS
  Baseline severity of migraine was higher in migraine with aura patients than in migraine without aura ones (8.8 vs. 7.5; P = 0.037). The resolution of migraine was verified in 11 patients (26%) after the closure of the PFO. A reduction in the frequency of the attacks (>=50%) was observed in 22 patients (52%). Multiple logistic regression analysis showed that the improvement in migraine with aura and migraine without aura was independent of migraine type, sex, age, cerebrovascular risk factors and cerebrovascular events, type of cardiac defect, and thrombophilic conditions.
  
  
  CONCLUSIONS
  The consistent observations of this and other studies are provocative and worthy of evaluation with a prospective randomized trial using objective measures of migraine frequency and severity. However, it seems too early to recommend PFO closure for all patients who suffer from migraine until the results of ongoing large randomized trials are available.
authors.affiliation: Department of Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS Policlinico San Donato, Milan, Italy. massimo.chessa@grupposandonato.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Chessa
authors.forename: Chiara
authors.initials: C
authors.lastname: Colombo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Butera
authors.forename: Diana
authors.initials: D
authors.lastname: Negura
authors.forename: Luciane
authors.initials: L
authors.lastname: Piazza
authors.forename: Leonardo
authors.initials: L
authors.lastname: Varotto
authors.forename: Claudio
authors.initials: C
authors.lastname: Bussadori
authors.forename: Vlasta
authors.initials: V
authors.lastname: Fesslova
authors.forename: Giovanni
authors.initials: G
authors.lastname: Meola
authors.forename: Mario
authors.initials: M
authors.lastname: Carminati
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D020325:Migraine with Aura / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome