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Patent Foramen Ovale Closure Associated With Less Frequent Migraine Symptoms: Presented at ISC

By Paula Moyer

KISSIMMEE, FL -- February 22, 2006 -- People with patent foramen ovale (PFO) who undergo endovascular closure appear to have less frequent migraine symptoms, according to investigators who presented their findings here at the annual meeting of the International Stroke Conference (ISC).

However, the findings do not yet point to PFO closure as a treatment for migraine, cautioned senior investigator David E. Thaler, MD. "We're not recommending PFO closure to treat migraines at this time," he said in an interview on February 17^th.

These findings show a potential role for PFO closure to treat migraines, and a trial is about to start that will investigate this potential treatment, said Dr. Thaler, who is Assistant Professor of Neurology, Tufts-New England Medical Center, and Director, Comprehensive Stroke Center, Boston, Massachusetts, United States.

His team examined a database of all transesophogeal echocardiograms (TEEs) performed at one center over a year, and they identified three groups: 40 patients with PFOs who were about to undergo endovascular closure (open PFO); 63 patients whose PFOs were treated medically (open PFO); and 63 age- and gender-matched controls without PFOs.

The investigators interviewed all of the subjects Migraine Disability ASsessment (MIDAS) questionnaire to determine whether they had migraine, whether the migraines were with or without aura, and the severity and frequency of the migraines.

Headache frequency and severity were assessed retrospectively using the Migraine Disability ASsessment (MIDAS) questionnaire at 3 months before and after the closure for the closed PFO group, and at 3 months before and after transesophageal echocardiography (TEE) for the open PFO and controls.

Migraines were more common in people with PFOs than in controls. They were reported by 58% of those in the closed PFO group, 41% of those in the open PFO group, and 16% of controls (P < .05 for both PFO groups compared to controls).

Among the 61 subjects with migraine, those in the closed PFO group reported significantly fewer and less severe migraines after the closure compared to 3 months before compared to the open PFO group and controls (P < .0001 for closed PFO compared to open PFO and controls).

In the closed group, 21 (52.5%) patients reported aura, compared to 25 (39.7%) of those in the open group and nine (14.3%) of those in the controls.

Of those in the closed PFO group with migraines, 19 (82.6%) reported a reduction in frequency after closure, while two (8.7%) each reported either that they had continued with the same frequency or become more frequent.

In the open PFO group, no patients (0%) reported a decrease in frequency, with 25 (96.2%) reporting the same frequency as 3 months before and one (3.9%) patient reporting an increase.

In the controls, one (10%) reported less frequent migraines than 3 months before, while nine (90%) reported that the frequency was the same and none (0%) reported worsening.


[Presentation title: Reduction in Migraine Symptoms Following PFO Closure: A Controlled Study. Abstract P336]

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