Migraine headache relief after transcatheter closure of patent foramen ovale

Reisman, Mark; Christofferson, Ryan D.; Jesurum, Jill T.; Olsen, John V.; Spencer, Merrill P.; Krabill, Kimberly A.; Diehl, Lance; Aurora, Sheena K.; Gray, William A.

doi:10.1016/j.jacc.2004.10.055

Cited by 225 publications

(155 citation statements)

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“…The resulting ischaemia or increased local levels of serotonin may stimulate trigeminal nerve endings, resulting in headache pain [9]. Although controversial, preliminary support for this theory has come from several non-randomised studies showing that transcatheter PFO closure resulted in either complete resolution or a significant (>50%) reduction in migraine symptoms [10][11][12]. Despite these findings, the importance of PFO in migraineurs continues to be debated because PFO is present in 20%-30% of the general population and in a large proportion of patients without vascular disorders [13].…”

Section: Introductionmentioning

confidence: 99%

Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal characteristics

et al. 2007

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The objective of the study was to assess differences in proportion of large right-to-left shunt (RLS) and atrial septal characteristics between migraineurs and non-migraineurs referred for transcatheter closure of patent foramen ovale (PF0). This retrospective study took place in a large metropolitan medical centre. The patients were migraineurs with aura (n=52), migraineurs without aura (n=19) and non-migraineurs (n=149). RLS was evaluated before closure using bilateral power m-mode transcranial Doppler at rest and after calibrated, sustained Valsalva manoeuvre, and graded with a validated 0-5 scale. Intracardiac echocardiography was used to assess atrial septal characteristics. Migraineurs had a higher proportion of large RLS (Grade IV or V) than nonmigraineurs at rest and after calibrated Valsalva (rest, p=0.04; Valsalva, p=0.01). Atrial septal characteristics were similar between groups. Migraine is associated with larger RLS at rest and strain; however migraine status does not predict PFO characteristics.

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Section: Introductionmentioning

confidence: 99%

Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal characteristics

et al. 2007

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“…PFO closure symptomatically improved or completely relieved migraines with and without aura in 18/21 subjects [37]. Subsequently, over 11 observational reports with 1632 subjects have corroborated these findings [ Table 2] [23], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47] and [48].…”

Section: Pfo and Migrainesmentioning

confidence: 68%

Patent foramen ovale: Unanswered questions

Mojadidi

Christia

Salamon

et al. 2015

European Journal of Internal Medicine

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The foramen ovale is a remnant of the fetal circulation that remains patent in 20-25% of the adult population. Although long overlooked as a potential pathway that could produce pathologic conditions, the presence of a patent foramen ovale (PFO) has been associated with a higher than expected frequency in a variety of clinical syndromes including cryptogenic stroke, migraines, sleep apnea, platypnea-orthodeoxia, deep sea diving associated decompression illness, and high altitude pulmonary edema. A unifying hypothesis is that a chemical or particulate matter from the venous circulation crosses the PFO conduit between the right and left atria to produce a variety of clinical syndromes. Although observational studies suggest a therapeutic benefit of PFO closure compared to medical therapy alone in patients with cryptogenic stroke, 3 randomized controlled trials (RCTs) did not confirm the superiority of PFO closure for the secondary prevention of stroke. However, meta-analyses of these RCTs demonstrate a significant benefit of PFO closure over medical therapy alone. Similarly, observational studies provide support for PFO closure for symptomatic relief of migraines. But one controversial randomized study failed to replicate the results of the observational studies while another two demonstrated a partial benefit. The goal of this review is to discuss the clinical conditions associated with PFO and provide internists and primary care physicians with current data on PFO trials, and clinical insight to help guide their patients who are found to have a PFO on echocardiographic testing. Embryology and anatomySince fetal lungs in utero are incapable of oxygenating blood, the fetus is dependent on the maternal circulation for oxygen delivery via the placenta. Oxygenated blood returning to the right atrium via the umbilical vein needs to be delivered to the brain and vital organs before further loss of oxygen occurs. To facilitate this rapid transit, an inter-atrial communication evolved in all mammals, known as the foramen ovale [1].After birth, the foramen ovale flap (the septum primum) physiologically closes against the septum secundum when pulmonary vascular resistance and right atrial pressure decrease. An atrial septal aneurysm (ASA), a saccular deformity of the atrial septum that protrudes 15 mm in the direction of either atria, is associated with 15% of PFOs and is often seen with the largest size PFO [3] and [4]. PFO imagingThe most accurate test for determining the presence of a PFO is a right heart catheterization with documentation of a guidewire crossing the atrial septum. The standard non-invasive method for diagnosing a PFO is transesophageal echocardiography (TEE) using agitated saline contrast [5]. Transcranial Doppler (TCD) is a more sensitive and less uncomfortable method for diagnosing PFO with a sensitivity of 97% and specificity of 93% [6]. Transthoracic echocardiogram (TTE) with bubble study is a less expensive, non-invasive test compared to TEE with comparable specificity [7] and [8]. Howeve...

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“…This improvement resulted in a decrease of 14%-80% in the frequency of migraine attacks, depending on the series, a decrease in the severity measured by disability scales and even disappearance of the migraine attacks and/or aura [23][24][25][26][27]. Our study cannot contribute anything of interest in this regard as it is not an interventional study.…”

Section: Discussionmentioning

confidence: 81%

Migraine, patent foramen ovale and migraine triggers

Tembl¹,

Lago²,

Sevilla³

et al. 2007

J Headache Pain

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Little information exists about a causal association between PFO and migraine. Some patients identify Valsalva-provoking activities (VPA) as migraine triggers. Therefore, we speculate about a pathogenic connection. The object of the study is to investigate the prevalence of right-to-left shunt (RLS) in a cohort of patients suffering migraine with aura (MA) and its possible association with migraine attacks triggered by VPA. We investigated the circumstances triggering the migraine attacks, in a consecutive series of 72 MA patients and in a series of migraine without aura age and gender-matched. The presence and extent of RLS was assessed by transcranial Doppler. Massive RLS appeared in 38.9% of MA and in 6.5% of migraine without aura ( p <0.001). MA patients identified at least one VPA as headache trigger in 45.8%. A trend was found between these triggering activities and massive RLS, both in MAgroup OR 2.7 [1.02–7.17] and in all migraine patients OR 2.5 [1.01–6.11]. According to our results, patients with migraine who have larger RLS tend to recognize activities that increase the extent of the shunt as a trigger of their migraine attacks.

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Migraine headache relief after transcatheter closure of patent foramen ovale

Abstract: In patients with paradoxical cerebral embolism, migraine headaches are more frequent than in the general population, and transcatheter closure of the PFO results in complete resolution or marked reduction in frequency of migraine headache.

Cited by 225 publications

References 10 publications

Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal characteristics

Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal characteristics

Patent foramen ovale: Unanswered questions

Migraine, patent foramen ovale and migraine triggers

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