Systematic review and meta-analysis of currently available clinical evidence on migraine and patent foramen ovale percutaneous closure: much ado about nothing?
OBJECTIVE
To investigate the role of transcatheter closure of patent foramen ovale on the occurrence of migraine.


BACKGROUND
In recent years, a potential relationship between, migraine, stroke, and patent foramen ovale (PFO) has emerged.


METHODS
BioMedCentral, Google Scholar, and PubMed from January 2000 to December 2008 were systematically searched for pertinent clinical studies. Secondary sources were also used. Secondary prevention studies of transcatheter closure for patent foramen ovale were required to include at least more than 10 patients followed for more than 6 months. The primary end-point was the rate of cured or significantly improved migraine after percutaneous PFO closure.


RESULTS
After excluding 637 citations, we finally included a total of 11 studies for a total of 1,306 patients. Forty percent of the subjects included suffered from migraine, while most had a previous history of transient ischemic attack/stroke and were investigated retrospectively. Quantitative synthesis showed that complete cure of migraine in 46% (95% C.I.25-67%), while resolution or significant improvement of migraine occurred in 83% (95% C.I. 78-88%) of cases.


CONCLUSIONS
Notwithstanding the limitations inherent in the primary studies, this systematic review suggests that a significant group of subjects with migraine, in particular if treated after a neurological event, may benefit from percutaneous closure of their patent foramen ovale. However, many questions remain unsolved.
Butera
Gianfranco
G
Department of Pediatric Cardiology and GUCH unit, Policlinico San Donato, IRCCS, San Donato Milanese, Italy. gianfra.but@lycos.com
Biondi-Zoccai
Giuseppe G L
GG
Carminati
Mario
M
Caputi
Luigi
L
Usai
Susanna
S
Bussone
Gennaro
G
Meola
Giovanni
G
Delogu
Angelica Bibiana
AB
Sheiban
Imad
I
Sangiorgi
Giuseppe
G
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D019317:Evidence-Based Medicine; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome