Key result
Percutaneous PFO closure significantly reduced the mean Migraine Disability Assessment Score from 35.8 to 12.3 (P<0.03), and all patients with aura reported resolution.
Why the study?
Does left atrial dysfunction play a role in aura genesis in patients with patent foramen ovale undergoing transcatheter closure?
Observational (n=45)
Does left atrial dysfunction play a role in aura genesis in patients with patent foramen ovale undergoing transcatheter closure?
Left atrial dysfunction in patients with a patent foramen ovale may contribute to the genesis of migraine aura symptoms, which significantly improve following percutaneous closure.
May link left atrial dysfunction to aura genesis in PFO; hypothesis-generating and should not yet change practice.
BACKGROUND: It has been suggested that a left atrial (LA) dysfunction induced by large shunt and large atrial septal aneurysm (ASA) may act as a concurrent mechanism of arterial embolism in patients with patent foramen ovale (PFO) and prior stroke. We aimed to evaluate the potential contribution of this mechanism as trigger of migraine in patients with PFO. METHODS: From January 2007 to September 2009, we prospectively enrolled subjects with migraine who underwent percutaneous PFO closure. Echocardiographic parameter of LA dysfunction was evaluated: pre- and postoperative values were compared to values of different sex and heart rate matched populations: 30 healthy patients, 21 migraine patients without PFO (MwoPFO), and a group of 25 PFO patients without migraine (PFOwoM). The Migraine Disability Assessment Score (MIDAS) was used to assess the incidence and severity of migraine. RESULTS: Forty-five patients (38 females, mean age 38 +/- 6.7 years, mean MIDAS 35.8 +/- 4.7, and 28 patients with migraine with aura) fulfilled the inclusion criteria. After successful percutaneous closure (mean follow-up of 18.2 +/- 4.8 months), PFO closure remained complete in 95%; 35 of 45 patients reported resolution or amelioration of migraine (mean MIDAS score 12.3 +/- 8.8, P < 0.03). All patients with aura reported aura resolution. Preclosure values demonstrated significantly greater LA dysfunction, when compared with healthy and MwoPFO groups. Among patients in the study group, only patients with migraine with aura showed LA dysfunction comparable to PFOwoM patients. CONCLUSION: This study suggests that LA dysfunction probably does not contribute to migraine itself but may play a role in the genesis of aura symptoms.
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Rigatelli et al. (2010) conducted an observational in Migraine with patent foramen ovale (n=45). Percutaneous PFO closure vs. Pre-closure baseline was evaluated on Migraine Disability Assessment Score (MIDAS) (p=<0.03). Percutaneous PFO closure significantly reduced the mean Migraine Disability Assessment Score from 35.8 to 12.3 (P<0.03), and all patients with aura reported resolution.
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