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Frequency of Migraine Headache Relief Following Patent Foramen Ovale “Closure” Despite Residual Right-to-Left Shunt

      Retrospective studies have shown improvement in migraines after patent foramen ovale (PFO) closure. To date, no study has evaluated whether the completeness of closure affects headache status; therefore, the objective of this study was to evaluate the impact of residual right-to-left shunt (RLS) on migraine symptoms after transcatheter PFO closure in migraineurs with and without aura. This was a small-series, single-center, retrospective analysis of late follow-up data on 77 patients with presumed paradoxical embolism and migraine who underwent PFO closure for secondary stroke prevention. Power M-mode transcranial Doppler was used to assess RLS at baseline and 6 and 12 months after closure. A standardized migraine questionnaire was administered at baseline and 6, 12, and 24 months after closure. Fifty-five (71%) patients had migraine with aura. Final closure and migraine status were available for 67 patients; 23 (34%) had incomplete PFO closure, defined as 30 embolic tracks detected at final power M-mode transcranial Doppler examination (median 366 days, 95% confidence interval 332 to 474). Migraine relief (≥50% reduction in frequency) was independent of closure status (77% complete closure vs 83% incomplete closure, p = 0.76) at late follow-up (540 days, 95% confidence interval 537 to 711). Migraineurs with aura were 4.5 times more likely to experience migraine relief than migraineurs without aura. In conclusion, migraine relief may occur despite residual RLS after transcatheter PFO closure, which may suggest a reduction in RLS burden below a neuronal threshold that triggers migraine; however, this warrants further investigation. Migraine with aura may be an independent predictor of relief after PFO closure.
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      References

        • Martin F.
        • Sanchez P.L.
        • Doherty E.
        • Colon-Hernandez P.J.
        • Delgado G.
        • Inglessis I.
        • Scott N.
        • Hung J.
        • King M.E.
        • Buonanno F.
        • Demirjian Z.
        • et al.
        Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism.
        Circulation. 2002; 106: 1121-1126
        • Harms V.
        • Reisman M.
        • Fuller C.J.
        • Spencer M.P.
        • Olsen J.V.
        • Krabill K.A.
        • Gray W.A.
        • Jesurum J.T.
        Outcomes after transcatheter closure of patent foramen ovale in patients with paradoxical embolism.
        Am J Cardiol. 2007; 99: 1312-1315
        • Slavin L.
        • Tobis J.M.
        • Rangarajan K.
        • Dao C.
        • Krivokapich J.
        • Liebeskind D.S.
        Five-year experience with percutaneous closure of patent foramen ovale.
        Am J Cardiol. 2007; 99: 1316-1320
        • Azarbal B.
        • Tobis J.
        • Suh W.
        • Chan V.
        • Dao C.
        • Gaster R.
        Association of interatrial shunts and migraine headaches: impact of transcatheter closure.
        J Am Coll Cardiol. 2005; 45: 489-492
        • Reisman M.
        • Christofferson R.D.
        • Jesurum J.
        • Olsen J.V.
        • Spencer M.P.
        • Krabill K.A.
        • Diehl L.
        • Aurora S.
        • Gray W.A.
        Migraine headache relief after transcatheter closure of patent foramen ovale.
        J Am Coll Cardiol. 2005; 45: 493-495
        • Schwerzmann M.
        • Wiher S.
        • Nedeltchev K.
        • Mattle H.P.
        • Wahl A.
        • Seiler C.
        • Meier B.
        • Windecker S.
        Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks.
        Neurology. 2004; 62: 1399-1401
        • Zanchetta M.
        • Rigatelli G.
        • Onorato E.
        Intracardiac echocardiography and transcranial Doppler ultrasound to guide closure of patent foramen ovale.
        J Invas Cardiol. 2003; 15: 93-96
        • Hanley P.C.
        • Tajik A.J.
        • Hynes J.K.
        • Edwards W.D.
        • Reeder G.S.
        • Hagler D.J.
        • Seward J.B.
        Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases.
        J Am Coll Cardiol. 1985; 6: 1370-1382
      1. The International Classification of Headache Disorders: 2nd edition.
        Cephalalgia. 2004; 24: 9-160
        • Spencer M.P.
        • Moehring M.A.
        • Jesurum J.
        • Gray W.A.
        • Olsen J.V.
        • Reisman M.
        Power m-mode transcranial Doppler for diagnosis of patent foramen ovale and assessing transcatheter closure.
        J Neuroimaging. 2004; 14: 342-349
        • Gori S.
        • Morelli N.
        • Fanucchi S.
        • Gallerini S.
        • Manca M.L.
        • Orlandi G.
        • Murri L.
        The extent of right-to-left shunt fails to correlate with severity of clinical picture in migraine with aura.
        Neurol Sci. 2006; 27: 14-17
        • Kitano A.
        • Shimomura T.
        • Takeshima T.
        • Takahashi K.
        Increased 11-dehydrothromboxane B2 in migraine: platelet hyperfunction in patients with migraine during headache-free period.
        Headache. 1994; 34: 515-518
        • Zeller J.A.
        • Frahm K.
        • Baron R.
        • Stingele R.
        • Deuschl G.
        Platelet-leukocyte interaction and platelet activation in migraine: a link to ischemic stroke?.
        J Neurol Neurosurg Psychiatry. 2004; 75: 984-987
        • Schwedt T.J.
        • Dodick D.W.
        Patent foramen ovale and migraine-bringing closure to the subject.
        Headache. 2006; 46: 663-671
        • Sanchez-Del-Rio M.
        • Reuter U.
        • Moskowitz M.A.
        New insights into migraine pathophysiology.
        Curr Opin Neurol. 2006; 19: 294-298
        • Lauritzen M.
        Cortical spreading depression in migraine.
        Cephalalgia. 2001; 21: 757-760
        • Post M.C.
        • Luermans J.G.
        • Plokker H.W.
        • Budts W.
        Patent foramen ovale and migraine.
        Catheter Cardiovasc Interv. 2007; 69: 9-14
        • Schwerzmann M.
        • Nedeltchev K.
        • Meier B.
        Patent foramen ovale closure: a new therapy for migraine.
        Catheter Cardiovasc Interv. 2007; 69: 277-284
        • Jesurum J.T.
        • Fuller C.J.
        • Velez C.A.
        • Spencer M.P.
        • Krabill K.A.
        • Likosky W.H.
        • Gray W.A.
        • Olsen J.V.
        • Reisman M.
        Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal features.
        J Headache Pain. 2007; 8: 209-216
        • Anzola G.P.
        • Morandi E.
        • Casilli F.
        • Onorato E.
        Different degrees of right-to-left shunting predict migraine and stroke: data from 420 patients.
        Neurology. 2006; 66: 765-767
        • Tembl J.
        • Lago A.
        • Sevilla T.
        • Solis P.
        • Vilchez J.
        Migraine, patent foramen ovale and migraine triggers.
        J Headache Pain. 2007; 8: 7-12
        • Dalla Volta G.
        • Guindani M.
        • Zavarise P.
        • Griffini S.
        • Pezzini A.
        • Padovani A.
        Prevalence of patent foramen ovale in a large series of patients with migraine with aura, migraine without aura and cluster headache, and relationship with clinical phenotype.
        J Headache Pain. 2005; 6: 328-330
        • Renz J.
        • Jesurum J.T.
        • Fuller C.J.
        • Reisman M.
        • Spencer M.P.
        Diagnosis of secondary source of right-to-left shunt with balloon occlusion of patent foramen ovale and power m-mode transcranial Doppler.
        Stroke. 2007; 38: 489
        • Anzola G.P.
        • Frisoni G.B.
        • Morandi E.
        • Casilli F.
        • Onorato E.
        Shunt-associated migraine responds favorably to atrial septal repair: a case-control study.
        Stroke. 2006; 37: 430-434
        • Wessman M.
        • Terwindt G.M.
        • Kaunisto M.A.
        • Palotie A.
        • Ophoff R.A.
        Migraine: a complex genetic disorder.
        Lancet Neurol. 2007; 6: 521-532
        • Giardini A.
        • Donti A.
        • Formigari R.
        • Salomone L.
        • Palareti G.
        • Guidetti D.
        • Picchio F.M.
        Spontaneous large right-to-left shunt and migraine headache with aura are risk factors for recurrent stroke in patients with a patent foramen ovale.
        Int J Cardiol. 2007; 120: 357-362
        • van der Kuy P.-H.M.
        • Lohman J.J.H.M.
        A quantification of the placebo response in migraine prophylaxis.
        Cephalalgia. 2002; 22: 265-270
        • Dowson A.
        • Mullen M.J.
        • Peatfield R.
        • Muir K.
        • Khan A.A.
        • Wells C.
        • Lipscombe S.L.
        • Rees T.
        • De Giovanni J.V.
        • Morrison W.L.
        • et al.
        Migraine Intervention With STARFlex Technology (MIST) trial: a prospective, multicenter, double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache.
        Circulation. 2008; 117: 1397-1404
        • Lapergue B.
        • Rosso C.
        • Hadrane L.
        • Labreuche J.
        • Abboud H.
        • Brochet E.
        • Juliard J.M.
        • Amarenco P.
        Frequency of migraine attacks following stroke starts to decrease before PFO closure.
        Neurology. 2006; 67: 1099-1100