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Improvement of Migraine After Patent Foramen Ovale Percutaneous Closure in Patients With Subclinical Brain Lesions

A Case-Control Study

Carlo Vigna, MD, FESC^_*,_*, Nicola Marchese, MD^_*, Vincenzo Inchingolo, MD, Giuseppe Maria Giannatempo, MD, Michele Antonio Pacilli, MD^_*, Pietro Di Viesti, MD, Matteo Impagliatelli, MD^_*, Rosaria Natali, MD, Aldo Russo, MD^_*, Raffaele Fanelli, MD^_*, Francesco Loperfido, MD

^_* Department of Cardiology, Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo, Italy
Department of Neurology, Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo, Italy
Department of Radiology, Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo, Italy
Department of Cardiology, Catholic University Medical School, Rome, Italy

^_* Reprint requests and correspondence: Dr. Carlo Vigna, Department of Cardiology, Casa Sollievo della Sofferenza Hospital IRCCS, Viale Cappuccini, 71013 San Giovanni Rotondo (FG), Italy (Email: carlovigna{at}libero.it).

Objectives: We sought to evaluate the benefits on frequency and severity of migraine recurrence after patent foramen ovale (PFO) closure in patients with subclinical brain lesions at magnetic resonance imaging (MRI).

Background: Migraine improvement has been reported after PFO closure in patients with cerebrovascular symptomatic events. Subclinical brain MRI lesions are detectable in patients with PFO and in migraineurs.

Methods: A total of 82 patients with moderate/severe migraine, PFO, large right-to-left shunt, and subclinical brain MRI lesions were prospectively examined for a 6-month period. Patients were subdivided into closure (n = 53) and control (n = 29) group according to their consent to undergo percutaneous PFO closure. In controls, therapy for migraine was optimized. Six-month frequency and severity of migraine recurrence were compared with baseline.

Results: The number of total attacks decreased more in the closure group (32 ± 9 to 7 ± 7, p < 0.001) than in the control group (36 ± 13 to 30 ± 21, p = NS) (p < 0.001). A significant reduction in disabling attacks was observed only in the closure group (20 ± 12 to 2 ± 2, p < 0.001; controls: 15 ± 12 to 12 ± 12, p = NS). Migraine disappeared in 34% of the closure group patients and 7% of controls (p = 0.007); >50% reduction of attacks was reported by 87% and 21%, respectively (p < 0.001). Disabling attacks disappeared in 53% of closure group patients and 7% of controls (p < 0.001); >50% reduction occurred in 89% and 17%, respectively (p < 0.001).

Conclusions: In migraineurs with a large PFO and subclinical brain MRI lesions, a significant reduction in frequency and severity of migraine recurrence can be obtained by PFO closure when compared with frequency and severity in controls.

Key Words: patent foramen ovale closure • migraine • subclinical brain lesions

Abbreviations and Acronyms   MES = microembolic signals   MRI = magnetic resonance imaging   PFO = patent foramen ovale   RLS = right-to-left shunt   TCCD = contrast transcranial color Doppler   VM = Valsalva maneuver

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J. Am. Coll. Cardiol. Intv. 2009 2: 114-115. [Full Text] [PDF]

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				P. Wilmshurst The Effect of Persistent Foramen Ovale Closure on Migraine Remains an Enigma J. Am. Coll. Cardiol. Intv., February 1, 2009; 2(2): 114 - 115. [Full Text] [PDF]