Abstract
BackgroundThe association between patent foramen ovale (PFO) and migraine with aura (MA) is well established. However, the benefits of PFO closure are less certain in patients with migraine without aura (MwoA).MethodsWe systematically searched Pubmed for pertinent clinical studies published from January 2000 to July 2015. The primary end-point was the elimination or significant improvement of migraine symptoms after PFO closure.ResultsUpon screening an initial list of 315 publications, we identified eight studies that included 546 patients. Overall, our analysis indicated a significant improvement of migraine in 81% of MA cases compared to only 63% of MwoA cases. The summary odds ratio was 2.5 (95% confidence interval 1.09–5.73), and the benefits of PFO closure were significantly greater for patients with MA compared to patients with MwoA (P = 0.03).ConclusionsThe presence of aura provides a reference standard for the clinical selection of patients with migraine for PFO closure intervention.
Highlights
The association between patent foramen ovale (PFO) and migraine with aura (MA) is well established
The cardiac anomaly known as patent foramen ovale (PFO), which is characterized by a hole in the heart that did not close properly after birth, has been implicated in the etiology of migraine attacks
The inclusion criteria were as follows: (i) observational studies that examined the effect of PFO closure on migraine; (ii) distinction of MA and migraine without aura (MwoA) as defined by the criteria of the International Headache Society; (iii) PFO detected either by transthoracic echocardiography with peripheral injection, transoesophageal echocardiography with peripheral injection, or transcranial Doppler ultrasonography with injection; (iv) participants were 18 to 60 years of age; (v) a minimum of 10 patients in each group; and (iv) mean duration of follow-up of at least 6 months
Summary
The association between patent foramen ovale (PFO) and migraine with aura (MA) is well established. The benefits of PFO closure are less certain in patients with migraine without aura (MwoA). The cardiac anomaly known as patent foramen ovale (PFO), which is characterized by a hole in the heart that did not close properly after birth, has been implicated in the etiology of migraine attacks. Several retrospective observational studies showed that approximately 80% of patients reported improvement of migraine attacks after PFO closure [5,6,7]. Several studies reported a significant decrease in the frequency of migraine attacks following PFO closure in patients with MA, whereas patients with MwoA did not benefit from the treatment [12, 13]. In order to clarify the relevance of the aura in the decision to undertake PFO closure, we conducted a meta-analysis to test for population differences in the response of migraineurs to PFO closure
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