Transcatheter patent foramen ovale closure mitigates aura migraine headaches abolishing spontaneous right-to-left shunting

Giardini, Alessandro; Donti, Andrea; Formigari, Roberto; Salomone, Luisa; Prandstraller, Daniela; Bonvicini, Marco; Palareti, Gualtiero; Guidetti, Donata; Gaddi, Oscar; Picchio, Fernando Maria

doi:10.1016/j.ahj.2005.09.019

Cited by 61 publications

(48 citation statements)

References 19 publications

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“…Moreover, the remarkable improvement of the Rankin scale in patients admitted with stroke diagnosis (who are the majority), demonstrated that the catheterbased therapy is effective not only for secondary prevention but also in terms of improvement of considerable improvement in migraine attacks frequency and or intensity after PFO closure (61%), especially in those patients whose migraine is preceded by aura, is in line with the literature data (13,14) and can offers in some cases a cure since migraine represents today an important health problem accounting for a high social cost due to the fact that heavily affect the quality of life, not to mention that, some observational studies reported that migraine may be for itself a risk for subclinical brain lesions and stroke. (15) The principal determinant of a successful procedure is the choice of the appropriate device for the specific morphology of the defect.…”

Section: Discussionsupporting

confidence: 76%

Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism

Pollice¹,

Pollice²,

Jacob³

2014

ejcm

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SummaryAim: Cryptogenic stroke remains the final diagnosis in 40% of ischemic acute cerebrovascular events. Until now there are no clinical evidences that the percutaneous closure of PFO is able to prevent the recurrence of stroke or transient ischemic attack (TIA). The aim of this study was to evaluate the incidence of recurrence in patients successfully. Treated by percutaneous closure of PFO with different occlude devices by using TDC, TTE and clinical evaluation. Material and Method:From June 2004 to February 2010, 72 PTS, (40 females and 32 males; everage age 46 yrs, range 14-66), admitted with diagnosis of recurrent ischemic neurologic events (58 stroke and 14 TIA)underwent percutaneous closure of PFO. Thirty-one (43%) of the 72 patients had a concomitant history of migraine, 16(52%) of whom with aura. Five different occlude devices were used, with a total amount of 74 implants. All pts were studied during the follow-up by clinical evaluation (Rankin modified scale), TCD and TTE.Results: Successful device deployment is achieved in 100% of pts without any periprocedural major complication. Only in two pts atrial arrhythmia have occurred. All pts was discharged within 3 days in good overall conditions. In all pts a double antiplatelet regimen was adopted. The follow-up was complete in 100% of the cases (median 30, range 3-58 months). At five years, there was no recurrent stroke or TIA, and no new cerebral lesions developed by MRI in those patients with residual shunt. Moreover, in 65 (90%)of them the Rankin scale significantly (P<0.0001) reduced to 0 whereas only in 2 pts score 1 was reached. In 19 (61%) of the 31 pts with concomitant migraine, the intensity and the frequency of the attacks significantly (P<0.0001) decreased over time. At the TCD, 5 pts (7%) resulted positive for microembolic signals but, only 1 of them, was successfully treated for an associate defect. The TTE evaluation showed however an optimal sealing of all the devices without signs of erosion, incomplete closure and thrombus formation around the device. Conclusion:Our experience suggests that percutaneous treatment of PFO is safe and beneficial at the medium term follow-up for secondary prevention since able to prevent the clinical recurrence of acute cerebrovascular events irrespective of the device used.Keywords: Stroke, paradoxical embolism, percutaneous transcatheter.Pollice F, Pollice P, Jacob L. Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism.

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Section: Discussionsupporting

confidence: 76%

Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism

Pollice¹,

Pollice²,

Jacob³

2014

ejcm

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“…Support for this second hypothesis can be found in observational studies that show several types of thrombophilia to be an independent risk factor for patients with a PFO and migraine with aura [50]. Additional evidence is demonstrated by the fact that anticoagulation therapy improves the severity of migraine attacks, an observation that cannot be explained by the first hypothesis [51].…”

Section: The Relationship Between Migraine and Pfomentioning

confidence: 92%

“…Of a group of patients who underwent closure because of cryptogenic stroke, 35 suffered from migraine headaches with aura. After a mean follow-up of approximately 2 years, migraine symptoms disappeared completely in 29 of 35 patients as measure by the Migraine Disability Assessment questionnaire, and in three of the remaining six patients, there was an improvement of at least two grades in the incidence and severity of symptoms [50].…”

Section: Effectiveness Of Pfo Closure In Treating Migrainesmentioning

confidence: 98%

Correlation or causation: Untangling the relationship between patent foramen ovale and migraine

Adler¹,

Love²,

Giovannone³

et al. 2007

Curr Cardiol Rep

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Observational evidence from the literature has shown an association between migraine headaches and patent foramen ovale (PFO). This observation has led to hypotheses that could explain the etiology of migraines in those with a PFO, including right-to-left shunting of venous agents such as serotonin that are normally broken down in the pulmonary circulation. Further evidence suggests that closure of a PFO may improve migraine symptoms and serve as an effective treatment modality for migraines. Several randomized controlled double-blinded studies are underway that will more definitively establish the role of specific devices in PFO closure in those suffering from migraines.

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“…Some uncontrolled reports indicated complete resolution of migraine symptoms in 56% of patients with migraine who were being treated with transcatheter PFO closure performed because of an episode of paradoxical embolism [30,Class III]. A recent case-controlled study showed a significant improvement in migraine score by 3.7 points in 23 stroke patients and by 2.6 points in 27 non-stroke patients treated with transcatheter closure of PFO [31,Class II]. A definitive determination of whether PFO closure reduces migraine attacks in patients with PFO (symptomatic and asymptomatic) for paradoxical embolism awaits the results of randomized, controlled clinical trials.…”

Section: Tissue Plasminogen Activatormentioning

confidence: 97%

Interactions between migraine and stroke

Weinberger

2006

Curr Treat Options Neurol

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When a patient with migraine has a stroke, all other causes of stroke should be ruled out before the stroke is attributed to migraine. Migraine mimics that present with headaches and stroke, including arteriovenous malformation and cervical carotid artery dissection, should be considered. Patent foramen ovale is a risk factor for both migraine and stroke and should be ruled out with transesophageal echocardiography. A patient with migraine with aura with persistent focal neurologic deficits in the distribution of the typical aura can be diagnosed with migrainous stroke. Patients with migraine with aura with persistent focal neurologic deficits can be treated pharmacologically with intravenous verapamil or magnesium sulfate to relieve the symptoms in familial hemiplegic migraine and sporadic hemiplegic migraine. Prophylactic treatment should be administered to patients with frequent attacks of migraine with aura to prevent recurrence. Oral verapamil is recommended for patients with familial hemiplegic migraine and may be effective in patients with sporadic hemiplegic migraine. Endovascular closure of patent foramen ovale has been reported to prevent recurrence of migraine with aura. The role of patent foramen ovale closure remains controversial pending completion of controlled randomized trials.

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Transcatheter patent foramen ovale closure mitigates aura migraine headaches abolishing spontaneous right-to-left shunting

Cited by 61 publications

References 19 publications

Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism

Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism

Correlation or causation: Untangling the relationship between patent foramen ovale and migraine

Interactions between migraine and stroke

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