title: Improvement of migraine after patent foramen ovale percutaneous closure in patients with subclinical brain lesions: a case-control study.
abstract: 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.
authors.affiliation: Department of Cardiology, Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo, Italy. carlovigna@libero.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Vigna
authors.forename: Nicola
authors.initials: N
authors.lastname: Marchese
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Inchingolo
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Giannatempo
authors.forename: Michele Antonio
authors.initials: MA
authors.lastname: Pacilli
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Viesti
authors.forename: Matteo
authors.initials: M
authors.lastname: Impagliatelli
authors.forename: Rosaria
authors.initials: R
authors.lastname: Natali
authors.forename: Aldo
authors.initials: A
authors.lastname: Russo
authors.forename: Raffaele
authors.initials: R
authors.lastname: Fanelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Loperfido
mesh_terms: 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