Improvement of migraine headaches after percutaneous closure of patent foramen ovale for secondary prevention of paradoxical embolism.
OBJECTIVE
Patent foramen ovale (PFO) has been linked to migraine, and an improvement in migraine prevalence or frequency has been reported after PFO closure for other reasons. We sought to identify whether there is a specific patient population of migraineurs which may be more susceptible to benefiting from PFO closure.


METHODS
Retrospective cohort study.


METHODS
Tertiary care centre. Participants 603 consecutive patients undergoing percutaneous PFO closure for secondary prevention of paradoxical embolism.


METHODS
PFO closure using the Amplatzer PFO occluder.


METHODS
Improvement of migraine symptoms.


RESULTS
150 patients (25%; aged 51+/-11 years) suffered from migraine, including 96 patients with migraine with aura. All implantation procedures were successful, without procedural complications. Contrast transoesophageal echocardiography at 6 months showed complete PFO closure in 136 patients (91%), whereas a minimal, moderate or large residual shunt persisted in 11 (7%), 2 (1%) or 1 (1%) patients, respectively. During 5.0+/-1.9 years of follow-up, one TIA and one ischaemic stroke occurred. Migraine headaches disappeared in 51 patients (34%) and improved in 72 additional patients (48%). Mean subjective improvement was 69+/-35%. Overall, mean headache frequency (from 2-3x/month to 1x/month; p<0.001), duration (from 4-72 to <4 h; p<0.001) and intensity (from 7+/-2 to 3+/-3; p<0.001) improved significantly. The prevalence of any migraine headaches (from 100% to 66%; p<0.001), migraine with aura (from 64% to 19%; p<0.001) and the number of patients taking any migraine medication (from 90% to 50%; p<0.001) decreased significantly. Both the presence of aura (OR 3.2; 95%CI 1.3 to 8.2; p=0.014) and high pain intensity at baseline (pain scale >5; OR 3.3; 95%CI 1.3 to 8.4; p=0.013) were independent predictors of response to PFO closure. A residual shunt had no influence on migraine improvement (OR 0.6; 95%CI 0.1 to 2.3; p=0.42).


CONCLUSIONS
These results suggest that percutaneous PFO closure durably alters the spontaneous course of shunt-associated migraine, especially but not exclusively in case of migraine with aura.
Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
Andreas
A
Wahl
Fabien
F
Praz
Tony
T
Tai
Oliver
O
Findling
Nazan
N
Walpoth
Krassen
K
Nedeltchev
Markus
M
Schwerzmann
Stephan
S
Windecker
Heinrich P
HP
Mattle
Bernhard
B
Meier
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology / Q000517:prevention & control*; D020325:Migraine with Aura / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome; D055815:Young Adult