Beneficial effect of PFO closure with the intrasept device on the incidence of migraine headache

Patent foramen ovale (PFO) may be involved in the development of migraine in some patients. We evaluated the possible beneficial role of PFO closure in patients referred to our institution for this closure. All patients completed the international headache questionnaire to determine migraine status before treatment and again at 6 months and 1 year after PFO closure. Before intervention, each patient was evaluated clinically by transthoracic and transoesophageal echocardiography. Closure of PFO was attempted in 123 patients (58 men and 65 women) with a mean age of 51 ± 10 years. Twentyeight of these patients (16%) (16 women and 12 men) had true migraine attacks prior to intervention. All patients were treated medically with anti-inflammatory drugs or triptan derivates before intervention. At 6 month the PFO was completely closed at rest in 94% of patients. A small (grade 2) residual shunt was present during Valsalva in 14% of patients. All patients received antiplatelet therapy (acetylsalicylic acid [ASA] and clopidogrel) for 6 months. Among the 28 patients with migraine, 10 patients (37%) were completely free of migraine and another 10 patients (37%) reported a significant improvement in their symptoms with less attacks, less pain and were taking less medication. Five patients (19%) had no change and 1 patient (7%) had a significant worsening of his symptoms. Finally 1 patient (1%) without migraine before the intervention started to have migraine attacks during follow-up. Four patients with migraine had residual shunt of which two were improved and 2 had no changes in their symptoms. Our data confirmed a possible positive effect of PFO closure in the prevention and treatment of migraine.