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Patent foramen ovale closure: A new therapy for migraine
Author(s) -
Schwerzmann Markus,
Nedeltchev Krassen,
Meier Bernhard
Publication year - 2007
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20966
Subject(s) - patent foramen ovale , migraine , medicine , aura , migraine with aura , decompression illness , stroke (engine) , randomized controlled trial , foramen secundum , anesthesia , surgery , pediatrics , cardiology , decompression sickness , decompression , engineering , mechanical engineering
Migraine is a recurrent disabling disorder predominantly affecting middle‐aged women. Migraine occurs with or without aura symptoms. Several studies have shown an increased prevalence of right‐to‐left shunts (RLSs) in migraine with aura. The overwhelming majority of these shunts were due to a patent foramen ovale (PFO). Furthermore, migraine with aura is more prevalent in clinical entities associated with a RLS, e.g. cryptogenic stroke, decompression illness in divers, or in patients with hereditary hemorrhagic teleangiectasia and pulmonary arteriovenous fistulas. Retrospective studies have consistently shown that shunt closure was associated with a significant reduction in migraine frequency. Its beneficial effect seemed to exceed the efficacy of conventional migraine therapy. Several randomized clinical trials to prospectively assess the benefit of shunt closure in migraine patients have been initiated. The only one completed, the MIST trial (Migraine Intervention with STARFLEX Technology), showed a significant reduction of migraine with aura after device implantation, compared with controls. However, the benefit of PFO closure was more modest than expected. This review recapitulates the current data regarding PFO closure and migraine with aura and summarizes in brief the current knowledge regarding migraine pathophysiology and the link to a RLS. © 2006 Wiley‐Liss, Inc.