Key result
Percutaneous patent foramen ovale closure in 42 migraineurs resulted in migraine resolution in 26% of patients and a ≥50% reduction in attack frequency in 52% at 6 months.
Why the study?
Does patent foramen ovale (PFO) percutaneous closure improve migraine severity in patients with migraine?
Cohort (n=42)
No
Does patent foramen ovale (PFO) percutaneous closure improve migraine severity in patients with migraine?
PFO closure in migraineurs resulted in migraine resolution in 26% and significant reduction in attack frequency in 52% of patients at 6 months, though randomized trials are needed before routine recommendation.
Answers are grounded in this paper and cite their sources.
Should not change migraine practice; leaves open benefit pending randomized confirmation.
PURPOSE OF REVIEW: To evaluate the course of migraine in migraine headache patients undergoing patent foramen ovale (PFO) transcatheter closure. BACKGROUND: Migraine has an important impact on the quality of life, and it seems to be one of the most disabling medical illnesses. In several studies, a high prevalence of right-to-left shunt has been described in patients with migraine, especially migraine with aura. The presence of right-to-left shunt, whatever the mechanism, may be the most potent trigger of migraine attacks in both migraine with aura and migraine without aura and the main determinant of aura in migraine with aura. METHODS: A cohort of 42 patients (nine men/33 women; mean age 39 +/- 11.2 years), current migraineurs, underwent PFO percutaneous closure in our centre between January 2004 and December 2007. All patients rated the severity of their migraine preoperatively and 6 months postoperatively, indicating the frequency, duration, and intensity of the attacks and the occurrence of the aura in the prodromal phase, during the past 6 months, according to the migraine severity score. RESULTS: Baseline severity of migraine was higher in migraine with aura patients than in migraine without aura ones (8.8 vs. 7.5; P = 0.037). The resolution of migraine was verified in 11 patients (26%) after the closure of the PFO. A reduction in the frequency of the attacks (>=50%) was observed in 22 patients (52%). Multiple logistic regression analysis showed that the improvement in migraine with aura and migraine without aura was independent of migraine type, sex, age, cerebrovascular risk factors and cerebrovascular events, type of cardiac defect, and thrombophilic conditions. DISCUSSION: The consistent observations of this and other studies are provocative and worthy of evaluation with a prospective randomized trial using objective measures of migraine frequency and severity. However, it seems too early to recommend PFO closure for all patients who suffer from migraine until the results of ongoing large randomized trials are available.
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Chessa et al. (2009) conducted a cohort in Migraine (n=42). Patent foramen ovale (PFO) transcatheter closure was evaluated on Resolution of migraine. Percutaneous patent foramen ovale closure in 42 migraineurs resulted in migraine resolution in 26% of patients and a ≥50% reduction in attack frequency in 52% at 6 months.
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