American Heart Journal
Volume 151, Issue 4 , Pages 922.e1-922.e5, April 2006

Transcatheter patent foramen ovale closure mitigates aura migraine headaches abolishing spontaneous right-to-left shunting

  • Alessandro Giardini, MD

      Affiliations

    • Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy
    • Corresponding Author InformationReprint requests: Alessandro Giardini, MD, Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
    • ,
  • Andrea Donti, MD

      Affiliations

    • Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy
    • ,
  • Roberto Formigari, MD

      Affiliations

    • Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy
    • ,
  • Luisa Salomone, MD

      Affiliations

    • Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy
    • ,
  • Daniela Prandstraller, MD

      Affiliations

    • Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy
    • ,
  • Marco Bonvicini, MD

      Affiliations

    • Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy
    • ,
  • Gualtiero Palareti, MD

      Affiliations

    • Department of Angiology, University of Bologna, Italy
    • ,
  • Donata Guidetti, MD

      Affiliations

    • Department of Neurology, Santa Maria Nuova Hospital, Reggio Emilia, Italy
    • ,
  • Oscar Gaddi, MD

      Affiliations

    • Department of Cardiology, Santa Maria Nuova Hospital, Reggio Emilia, Italy
    • ,
  • Fernando Maria Picchio, MD

      Affiliations

    • Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy

Received 18 July 2005; accepted 21 September 2005.

Background

Patent foramen ovale (PFO) has been implicated in the etiology of migraine headache with aura (MHA), but the mechanisms that link right-to-left (R-to-L) shunt to MHA are unclear, and the reports on the efficacy of transcatheter PFO closure on MHA prevention are scarce.

Methods

We reviewed the clinical records of 131 consecutive patients who underwent successful transcatheter PFO closure at our institution at a mean age of 45 ± 13 years because of cryptogenic stroke. Of the 131 patients, 35 (27%) had a diagnosis of MHA made by the primary care physician or the referring neurologist. Migraine headache with aura incidence and severity were assessed by using Migraine Disability Assessment (MIDAS) questionnaire. Presence and magnitude of R-to-L shunt were assessed in all patients by means of transesophageal echocardiography and also by means of transcranial Doppler (TCD) in the last 50 patients (38%).

Results

Patients with MHA had a higher prevalence of thrombophilia (P = .007), a more complex atrial septal anatomy (P = .001), and they also had higher prevalence of spontaneous R-to-L shunt and of spontaneous large shunt, both at transesophageal echocardiography (P = .015, and .028, respectively) and at TCD (P = .036, and .038, respectively). After the procedure, 32 (91%) of 35 patients had either complete resolution or significant improvement in their MHA. At a mean follow-up of 1.7 ± 1.3 years, MHA disappeared completely in 29 (83%) of 35 patients. Of the remaining 6 patients, 3 patients (8%) had an improvement of ≥2 grades in the incidence and severity of MHA, 2 patients did not show any improvement of their MHA, whereas 1 patient reported a severe relapse of MHA about 1 year after the procedure.

Conclusions

In patients with PFO, MHA is associated with spontaneous large R-to-L shunt and thrombophilic conditions. Transcatheter defect closure seems to be an effective and safe means to treat MHA in patients with PFO.

 

PII: S0002-8703(05)00875-6

doi:10.1016/j.ahj.2005.09.019

American Heart Journal
Volume 151, Issue 4 , Pages 922.e1-922.e5, April 2006

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