Percutaneous closure of patent foramen ovale for migraine headaches refractory to medical treatment

Wahl, Andreas; Praz, Fabien; Findling, Oliver; Nedeltchev, Krassen; Schwerzmann, Markus; Tai, Tony; Windecker, Stephan; Mattle, Heinrich P; Meier, Bernhard (2009). Percutaneous closure of patent foramen ovale for migraine headaches refractory to medical treatment. Catheterization and cardiovascular interventions, 74(1), pp. 124-9. Hoboken, N.J.: Wiley-Blackwell 10.1002/ccd.21921

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BACKGROUND: Patent foramen ovale (PFO) has been linked to migraine, and several retrospective studies reported an improvement in migraine prevalence or frequency after PFO closure for other reasons, mostly for secondary prevention of paradoxical embolism or following diving accidents. We investigated the outcome of patients undergoing PFO closure solely for migraine headaches refractory to medical treatment. METHODS: Seventeen patients (age 44 +/- 12 years; 76% female; one atrial septal aneurysm) underwent percutaneous PFO closure using the Amplatzer PFO Occluder (AGA Medical Corporation, Golden Valley, MN). An 18-mm device was used in two patients, a 25-mm device in 13, and a 35-mm device in two. The interventions were solely guided by fluoroscopy, without intraprocedural echocardiography. RESULTS: All implantation procedures were successful. There were no peri-procedural complications. Contrast transesophageal echocardiography after Valsalva maneuver at 6 months showed complete PFO closure in 16 patients (94%), whereas a minimal residual shunt persisted in one (6%). During 2.7 +/- 1.5 years of follow-up, no deaths and no embolic events occurred. After PFO closure, migraine headaches disappeared in four patients (24%), and improved in eight additional patients (47%). Three patients (18%) reported a decrease of their headaches by 75%, three patients (18%) a decrease of 50%, and two patients (12%) a decrease of 25%, while headaches remained unchanged in five patients (29%). No patient experienced worsening headaches. Moreover, the prevalence of migraine with aura decreased from 82 to 24% (P = 0.002). CONCLUSIONS: These results suggest that percutaneous PFO closure durably alters the spontaneous course of shunt associated migraine.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Wahl, Andreas; Findling, Oliver; Schwerzmann, Markus; Windecker, Stephan; Mattle, Heinrich and Meier, Bernhard

ISSN:

1522-1946

ISBN:

19180663

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:02

Last Modified:

04 May 2014 23:18

Publisher DOI:

10.1002/ccd.21921

PubMed ID:

19180663

Web of Science ID:

000267928200024

URI:

https://boris.unibe.ch/id/eprint/26974 (FactScience: 99337)

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