To assess the long term efficacy of transcatheter Patent foramen ovale closure on migraine headache with aura (MHA) frequency in a 12 month follow-up period.
During an approximate 3-year time period, 37 patients presented for evaluation of trans-catheter PFO closure for prevention of cryptogenic stroke or transient ischemic attack (TIA) and were known to suffer from migraine headaches with aura (MHA). A one-year retrospective analysis of migraine symptoms before and after PFO closure was performed. A total of 33 subjects fulfilled the inclusion criteria. The incidence and severity of Migraine headache with aura was assessed using Migraine Disability Assessment (MIDAS) questionnaire. Transesophageal echocardiography (TEE) and Trans-cranial Doppler (TCD) were used to assess the presence and magnitudes of the Right-to-Left shunt in all 33 subjects (100%).
Patients with MHA were found to have a higher prevalence of spontaneous R-to-L shunt and of spontaneous larger shunt, evident both at transesophageal echocardiography (P = .015, and .028, respectively) and at TCD (P = .036, and .038, respectively). Immediately post catheter PFO closure, 85% (28/33) of the subjects reported either complete resolution or a significant improvement in their MHA. At a mean follow-up of 12 months, MHA disappeared completely in 79% (26/33) of subjects. Of the remaining 7 subjects, 3 were found to have an improvement of ≥ 2 grades in the incidence and severity of MHA, 2 failed to show any improvement at all, whereas 2 subjects reported severe relapse of MHA about 12 months after the procedure.
In patients who suffer from MHA and are found to have a PFO, trans-catheter closure of their septal defect results in complete resolution or marked reduction in the frequency of their migraine attacks.At long-term follow-up, the rate of recurrence remains low.
Trans-catheter defect closure seems to be an effective and safe means to treat MHA in patients with PFO.The positive effects of transcatheter PFO closure for the prevention and treatment of MHA seem to be maintained in long-term followup.
Aaref Badshah, No Financial Disclosure Information; No Product/Research Disclosure Information