A Nomogram for the Prediction of Cessation of Migraine Among Patients With Patent Foramen Ovale After Percutaneous Closure

Abstract

Objective: This study aimed to develop and validate a nomogram to predict cessation of patent foramen ovale (PFO) patients with migraine headache after percutaneous closure. Methods: A total of 247 eligible patients with PFO and migraine after percutaneous closure between May, 2016 and May, 2018 were divided into a development cohort (n = 149) and a validation cohort (n = 98). The primary end point was cessation of migraine at follow-up of 1 year after the procedure measured by the Migraine Disability Assessment Score (MIDAS). In the development cohort, the LASSO regression was used data dimension reduction. A multivariable logistic regression analysis was used to develop the predicting nomogram. The performance of the nomogram was assessed by concordance index (C-index), calibration and clinical usefulness. The results were validated in the validation cohort. Results: Migraine with aura, history of antiplatelet, and the right-to-left shunt (RLS) at rest were identified as significant predictors based on the analysis of multivariate logistic regression. The nomogram incorporating these variables showed good calibration and discrimination in the development cohort with C-index of 0.906 (95% CI: 0.847-0.965), which was confirmed using the validation cohort with C-index of 0.827 (95% CI: 0.751-0.903). The nomogram showed good agreement between prediction by nomogram and actual observation. Furthermore, the decision curve indicated that the novel nomogram was clinically useful. Conclusion: The novel nomogram showed favorable predictive accuracy for cessation of migraine among patients with PFO after percutaneous closure and might provide constructive guidance in clinical decision making.

The patent foramen ovale may alter migraine brain activity: A pilot study of electroencephalography spectrum and functional connectivity analysis

“…Although the PREMIUM and PRIMA trials failed to conclude that PFO closure is effective for migraineurs with PFO ( Mattle et al, 2016 ; Tobis et al, 2017 ), we still cannot say it is completely useless. A recent study developed a nomogram that included migraine with aura, antiplatelet history, and right-to-left shunt at rest had good predictive accuracy for migraine cessation in patients with PFO after PFO closure ( Zhao et al, 2020 ), which means that PFO closure is an effective treatment for at least some PFO migraineurs. This study demonstrates that changes in brain activity during photic stimulation, such as occipital beta band PSD, have the potential to be at least a supplementary marker for predicting the effectiveness of PFO closure for migraineurs with PFO.…”

Migraine pharmacology and brain ischemia

“…The association of migraine with patent foramen ovale, which is often complicated by ischemic brain damage, has been also found (Takagi and Umemoto 2015;Zhao et al 2020).…”