CLINICAL RESEARCH: MINI-FOCUS: TRANSCATHETER CLOSURE OF ASD AND PFO
Migraine headache relief after transcatheter closure of patent foramen ovale
Mark Reisman, MD*,
Ryan D. Christofferson, MD*,
Jill Jesurum, PhD*,*,
John V. Olsen, MD, FACC*,
Merrill P. Spencer, MD ,
Kimberly A. Krabill, MD*,
Lance Diehl, MD*,
Sheena Aurora, MD* and
William A. Gray, MD*
* Cardiovascular Research, Swedish Medical Center
Spencer Vascular Laboratories, Seattle, Washington
Manuscript received June 11, 2004;
revised manuscript received October 14, 2004,
accepted October 18, 2004.
* Reprint requests and correspondence: Dr. Jill Jesurum, 801 Broadway, Suite 927, Seattle, Washington 98104 (Email: jill.jesurum{at}swedish.org).
OBJECTIVES: The purpose of this study was to determine the effects of transcatheter patent foramen ovale (PFO) closure on migraine frequency in patients with paradoxical cerebral embolism.
BACKGROUND: The prevalence of migraine headache is higher in cryptogenic stroke patients with PFO than in the general population. Previous studies have suggested that closure of the PFO may reduce migrainous symptoms.
METHODS: Between April 2001 and December 2003, 162 consecutive patients with paradoxical cerebral embolism underwent transcatheter PFO closure for prevention of recurrent cryptogenic stroke or transient ischemic attack. A one-year retrospective analysis of migraine symptoms before and after PFO closure was performed.
RESULTS: Active migraine was present in 35% (57 of 162) of patients, and 68% (39 of 57) experienced migrainous aura; 50 patients were available for analysis at one year. Complete resolution of migraine symptoms occurred in 56% (28 of 50) of patients, and 14% (7 of 50) of patients reported a significant ( 50%) reduction in migraine frequency. Patients reported an 80% reduction in the mean number of migraine episodes per month after PFO closure (6.8 ± 9.6 before closure vs. 1.4 ± 3.4 after closure, p < 0.001). Results were independent of completeness of PFO closure at one year.
CONCLUSIONS: In patients with paradoxical cerebral embolism, migraine headaches are more frequent than in the general population, and transcatheter closure of the PFO results in complete resolution or marked reduction in frequency of migraine headache.
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Abbreviations and Acronyms
| | PFO = patent foramen ovale | | pm-TCD = power m-mode transcranial Doppler |
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