title: Sustained long-term benefit of patent foramen ovale closure on migraine.
abstract: OBJECTIVE
  This single-center, observational, prospective study evaluated the impact of patent foramen ovale (PFO) closure on migraine attacks over time.
  
  
  BACKGROUND
  PFO closure may reduce the frequency and severity of migraine headaches in patients with significant right-to-left shunts.
  
  
  METHODS
  Between May 2000 and September 2009, 305 consecutive patients (mean age, 43 ± 12 years; 54.5% women) with a prior embolic cerebrovascular event underwent PFO closure with the Amplatzer PFO occluder for recurrence prevention. All patients had right-to-left shunts; the shunts were associated with migraine symptoms in 77 (25%), either alone (n = 64, 83%) or with aura (n = 13, 17%). Septal aneurysm was present in 15 (19.5%) migraine patients, and 43 (56%) had a previous transient brain ischemic attack. All migraine patients had a computed tomography scan or magnetic resonance imaging, indicating a previous brain ischemic lesion. All 305 patients underwent transthoracic echocardiography with clinical follow-up at 24 hr, at 3, 6, and 12 months, and then yearly.
  
  
  RESULTS
  An acute migraine attack occurred 24-48 hr after PFO closure in 28 (36.4%) of 77 patients. There was a significant reduction (>50%) in the number and intensity of attacks in 46 (60.5%) of 77 patients at the 3-month follow-up. At the 12-month follow-up, migraine had ceased in 23 (46%) patients, and 20 (40%) had a reduction in the migraine recurrence rate and disabling symptoms. These results were maintained at follow-up (mean, 28 ± 27 months). There was overall improvement in migraine in 89% of the treated patients.
  
  
  CONCLUSIONS
  Percutaneous PFO closure in migraineurs may provide beneficial mid-term and long-term results, with significant reduction in the intensity and frequency of headache symptoms.
authors.affiliation: Centro Cardiologico Monzino, Department of Cardiovascular Sciences, University of Milan, Milan, Italy. daniela.trabattoni@ccfm.it
authors.forename: Daniela
authors.initials: D
authors.lastname: Trabattoni
authors.forename: Franco
authors.initials: F
authors.lastname: Fabbiocchi
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.forename: Stefano
authors.initials: S
authors.lastname: Galli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Teruzzi
authors.forename: Luca
authors.initials: L
authors.lastname: Grancini
authors.forename: Pamela
authors.initials: P
authors.lastname: Gatto
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011474:Prosthesis Design; D055502:Secondary Prevention; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial