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Patent Foramen Ovale Linked to Migraine with Aura: Presented at ESC(CARD)

By Peggy Peck

VIENNA, AUSTRIA -- September 3, 2003 -- Patent foramen ovale (PFO) is a triggering factor in many patients with migraine with aura, and repairing the defect can greatly reduce recurrent migraine attacks, a retrospective study from Swiss investigators suggests.

Stephan Windecker, MD, assistant professor of cardiology, Swiss Cardiovascular Center, Bern, reported the findings here August 31^st at the European Society of Cardiology Congress 2003.

When patients with PFO complain of migraine with aura "four out of five report a marked reduction in attacks after PFO repair." Dr. Windecker and colleagues assessed 215 patients with PFO-mediated paradoxical embolism.

"We used a detailed questionnaire to identify patients who had headaches before PFO repair and one year after repair," Dr. Windecker said. He noted that the questionnaires were administered after the patients had undergone percutaneous PFO closure using a variety of approved devices. "Thus, there is some chance of recall bias," he noted.

Headaches were classified using the International Headache Society criteria. Patients who reported experiencing headaches were asked to rate the headache severity using the Headache Impact Test (HIT), a standard test used to evaluate headaches. A HIT-6 score of more than 55 indicates "headaches that substantially impact quality of life."

Compared to historical controls, the incidence of migraine with aura was much higher in the PFO population, said Dr. Windecker. He said that 17% of the PFO patients said they had frequent migraine with aura, while only about 3% to 4% of the general population has this type of migraine.

The PFO patients reported that headache frequency declined dramatically after PFO repair; the relative reduction in attack frequency was 56% in the PFO patients who had a history of migraine with aura. "The procedure is also associated with a reduction in other types of headache—migraine without aura and tension headaches—but that reduction was much more modest," said Dr. Windecker.

Dr. Windecker said the results of his study suggest the need for larger studies of PFO and migraine, but said that it is too soon to assess all migraine patients for PFO.

Stephen H. Landy, MD, director, Wesley Headache Clinic and clinical associate professor, department of neurology, University of Tennessee, Memphis, Tennessee, said in an interview that Dr. Windecker's study is "definitely not off base. In fact, there have been numerous publications over the last few years regarding the increased prevalence of migraine with aura in patients with PFO and improvement with surgical or anticoagulant treatment to prevent brain embolism." Dr. Landy was not involved in this study, which Dr. Windecker said was self-funded.


[Study title: Percutaneous closure of patent foramen ovale reduces migraine frequency. Abstract 729]

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