Impact of transcatheter closure of patent foramen ovale in the evolution of migraine and role of residual shunt.
OBJECTIVE
To retrospectively evaluate the impact on daily activities of transcatheter closure of patent foramen ovale (PFO) versus medical therapy in patients with migraine and to analyze the role of the residual shunt after PFO closure.


BACKGROUND
While non-controlled observational studies reported an improvement of migraine after PFO closure, a randomized trial has shown no benefit of such an intervention. The role of residual shunt after PFO closure is also poorly known.


METHODS
Out of 217 patients with migraine and echocardiographic evidence of PFO, 89 were managed with percutaneous PFO closure (Group A) while 128 were medically treated (Group B). All MIDAS questionnaires were obtained at the first evaluation and repeated at least 6 months after the index evaluation or after the PFO closure. All the patients were also asked to give a subjective estimate of their migraine status. A postprocedural transcranial Doppler study was available in 70 patients in Group A.


RESULTS
The mean basal MIDAS score did not differ between the two groups (p = 0.859). After a mean follow-up (FU) of 1399 ± 982 days the MIDAS score decreased significantly in both groups (Group A baseline vs FU, p < 0.001; Group B baseline vs FU, p < 0.001), but no differences were observed between groups (p = 0.204). However a significantly higher number of Group A patients reported a perceived clinical benefit or the disappearance of migraine compared to Group B (p < 0.001). Patients with moderate or severe residual right to left shunt were no more likely to have an higher MIDAS score or to complain of migraine than those with mild or no shunt.


CONCLUSIONS
Although the overall evolution of migraine is not significantly different, the abolition of migraine occurs in a larger proportion after PFO closure.
Division of Cardiology, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy. Electronic address: luigi.biasco@gmail.com.
Luigi
L
Biasco
Division of Cardiology, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Vincenzo
V
Infantino
Division of Cardiology, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Fulvio
F
Orzan
Division of Cardiology, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Silvia
S
Vicentini
Division of Cardiology, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Chiara
C
Rovera
Division of Cardiology, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Giada
G
Longo
Division of Cardiology, Ospedale Maria Vittoria, Turin, Italy.
Alessandra
A
Chinaglia
Division of Cardiology, Ospedale Maria Vittoria, Turin, Italy.
Riccardo
R
Belli
Women's Headache Center, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Gianni
G
Allais
Division of Cardiology, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Fiorenzo
F
Gaita
D000203:Activities of Daily Living; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014463:Ultrasonography
Migraine; Patent foramen ovale; Transcatheter closure