Clinical analysis of transcatheter closure of patent foramen ovale in migraine

Abstract

Objective To investigate the effect of the transcatheter closure of patent foramen ovale (PFO) on the treatment of migraine. Methods This prospective clinical trial enrolled 43 consecutive migraine patients with PFO from Department of Neurology, Beijing Anzhen Hospital from March 2014 to March 2015, in which PFO was diagnosed by transesophageal echocardiography (TEE) and contrast-enhanced transcranial Doppler (c-TCD). We grouped subjects according to their selection or refusal of PFO closure. Nine patients were allocated to treatment with PFO closure. Thirty-four patients were given with medical treatment and were assigned to control group. Basal clinical data, frequency of migraine, duration of migraine and scores of Headache Impact Test-6 (HIT-6) were collected. c-TCD was performed after procedure of PFO closure transthoracic echocardiography. Changes of HIT-6 scores were analyzed after closure of PFO in the follow-up period. Results Successful PFO procedure was achieved in all patients without any complications both in hospital and in follow-up period. Only one patient had residual Ⅱ-grade right-to-left shunt (RLS) tested by c-TCD. Mean scores of HIT-6 in the surgical group were reduced significantly (49.3±3.6 vs 67.5±4.9, t=15.129, P=0.000). There were statistically significant differences in mean reduction of HIT-6 scores in the following one year for the female (48.8±3.1 vs 69.8±2.6, t=15.674, P=0.002), constant RLS (47.8±2.1 vs 67.9±3.5, t=8.572, P=0.043), RLS Ⅲ (50.6±2.3 vs 65.4±2.7, t=7.663, P=0.039)/ RLS Ⅳ(48.2±1.9 vs 68.5±3.9, t=8.924, P=0.028)as well as migraine with aura subgroup (47.9±1.6 vs 68.3±3.8, t=13.532, P=0.001). Conclusion Our results suggest that transcatheter PFO closure is a safe and effective approach for the treatment of migraine, especially for female migraineur with aura and with constant serious RLS. Key words: Migraine; Patent foramen ovale; Septal occluder device