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PFO Closure Brings Mixed Results for Migraineurs

Migraine headaches are more common in patients with a small hole in the heart called a patent foramen ovale (PFO), and some research has indicated that closing the hole helps alleviate migraine. However, a recent study evaluating PFO closure in patients with migraine with aura showed mixed results.

In the study of 107 patients (sign-in required) with migraine with aura who had not responded to previous treatment, PFO closure did not reduce the total number of migraine headaches within 1 year compared with medical intervention. However, the incidence of migraine with aura was decreased by the procedure.

The study experienced some attrition, leaving 41 patients who underwent PFO closure with a cardiac implant device, and the remainder receiving medical therapy.

Patients in both groups had approximately 8 migraine days per month before the study, and PFO closure resulted in a mean reduction of nearly 3 migraine days per month compared with less than 2 days per month for the group receiving medical treatment. The difference was not statistically significant, according to lead author David Hildick-Smith, MD, of Sussex Cardiac Center in Brighton, United Kingdom.

However, the closure was associated with a decrease in migraine with aura attacks and resulted in a reduction of 2.4 fewer days with migraine with aura each month compared to 0.6 in the medical treatment group.

The researchers deemed the PFO procedure safe, but reported one major vascular complication and one episode of atrial fibrillation in the PFO closure group.

The study has not been published and was presented at the Transcatheter Cardiovascular Therapeutics education meeting in September, in Washington, D.C.

Arthur Elkind, MD, the President of the National Headache Foundation, expressed caution about migraineurs undergoing PFO closure. The patients in this study who developed serious complications had to take medications for months afterward, he noted, adding that further study would be helpful to determine the benefits and risks to enable physicians to clearly advise migraine sufferers.
“At present I would be cautious in advising patients for PFO closure on the basis of their migraine with aura,” he said.

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