1
|
Liu K, Wang BZ, Hao Y, Song S, Pan M. The Correlation Between Migraine and Patent Foramen Ovale. Front Neurol 2020; 11:543485. [PMID: 33335507 PMCID: PMC7736411 DOI: 10.3389/fneur.2020.543485] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/28/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Migraine is a widespread neurological disorder. The patent foramen ovale (PFO) is a remnant of the fetal circulation. Multiple studies suggest that migraine is more prevalent in subjects with PFO and vice versa. It is unclear if there is a causal relationship or simply a co-existence of these two conditions. Furthermore, the treatment of migraine with percutaneous closure PFO remains controversial. Methods: We reviewed studies pertaining to the relationship between PFO and migraine as well as the effects of treatments on migraine attacks. Results: We briefly summarized potential pathophysiological mechanisms of migraine, and elaborated on migraine type, frequency, and clinical symptoms of migraine with PFO and the clinical features of PFO with migraine. We also addressed the effects of PFO closure on migraine attacks. Conclusion: The evidence supports a “dose-response” relationship between migraine and PFO although more work needs to be done in terms of patient selection as well as the inclusion of an antiplatelet control group for PFO closure interventions to uncover possible beneficial results in clinical trials.
Collapse
Affiliation(s)
- Kaiming Liu
- Department of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Brian Z Wang
- Nanyang Technological University Clinical Diagnostic Laboratory, NTU-Imperial Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Yishu Hao
- Department of Neurology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Shuijiang Song
- Department of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengxiong Pan
- Department of Neurology, The First People's Hospital of Huzhou, Huzhou, China.,Department of Neurology, The First Affiliated Hospital of Huzhou Teachers College, Huzhou, China
| |
Collapse
|
2
|
Shi YJ, Lv J, Han XT, Luo GG. Migraine and percutaneous patent foramen ovale closure: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17:203. [PMID: 28747203 PMCID: PMC5530487 DOI: 10.1186/s12872-017-0644-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background The association between patent foramen ovale (PFO) and migraine with aura (MA) is well established. However, the benefits of PFO closure are less certain in patients with migraine without aura (MwoA). Methods We systematically searched Pubmed for pertinent clinical studies published from January 2000 to July 2015. The primary end-point was the elimination or significant improvement of migraine symptoms after PFO closure. Results Upon screening an initial list of 315 publications, we identified eight studies that included 546 patients. Overall, our analysis indicated a significant improvement of migraine in 81% of MA cases compared to only 63% of MwoA cases. The summary odds ratio was 2.5 (95% confidence interval 1.09–5.73), and the benefits of PFO closure were significantly greater for patients with MA compared to patients with MwoA (P = 0.03). Conclusions The presence of aura provides a reference standard for the clinical selection of patients with migraine for PFO closure intervention. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0644-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yu-Jie Shi
- Department of Neurology, Xi'an Jiaotong University, Xi'an, China
| | - Jun Lv
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Xing-Ting Han
- Department of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Guo-Gang Luo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, China.
| |
Collapse
|
3
|
Mojadidi MK, Christia P, Salamon J, Liebelt J, Zaman T, Gevorgyan R, Nezami N, Mojaddedi S, Elgendy IY, Tobis JM, Faillace R. Patent foramen ovale: Unanswered questions. Eur J Intern Med 2015; 26:743-51. [PMID: 26489724 DOI: 10.1016/j.ejim.2015.09.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/26/2015] [Accepted: 09/27/2015] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Mohammad Khalid Mojadidi
- Division of Cardiology, University of Florida College of Medicine, Gainesville, FL, United States.
| | - Panagiota Christia
- Department of Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, NY, United States
| | - Jason Salamon
- Department of Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, NY, United States
| | - Jared Liebelt
- Department of Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, NY, United States
| | - Tarique Zaman
- Department of Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, NY, United States
| | - Rubine Gevorgyan
- Program in Interventional Cardiology, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Nariman Nezami
- Department of Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, NY, United States
| | - Sanaullah Mojaddedi
- Division of Cardiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Islam Y Elgendy
- Division of Cardiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Jonathan M Tobis
- Program in Interventional Cardiology, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Robert Faillace
- Department of Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, NY, United States
| |
Collapse
|
4
|
Lip PZY, Lip GYH. Patent foramen ovale and migraine attacks: a systematic review. Am J Med 2014; 127:411-20. [PMID: 24355354 DOI: 10.1016/j.amjmed.2013.12.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Migraine headache and the presence of a patent foramen ovale have been associated with each other, although the precise pathophysiological mechanism(s) are uncertain. The purpose of this systematic review was to identify the extent of patent foramen ovale prevalence in migraineurs and to determine whether closure of a patent foramen ovale would improve migraine headache. METHODS An electronic literature search was performed to select studies between January 1980 and February 2013 that were relevant to the prevalence of patent foramen ovale and migraine, and the effects of intervention(s) on migraine attacks. Of the initial 368 articles presented by the initial search, 20 satisfied the inclusion criteria assessing patent foramen ovale prevalence in migraineurs and 21 presented data on patent foramen ovale closure. RESULTS In case series and cohort studies, patent foramen ovale prevalence in migraineurs ranged from 14.6% to 66.5%. Case-control studies reported a prevalence ranging from 16.0% to 25.7% in controls, compared with 26.8% to 96.0% for migraine with aura. The extent of improvement or resolution of migraine headache attack symptoms was variable. In case series, intervention ameliorated migraine headache attack in 13.6% to 92.3% of cases. One single randomized trial did not show any benefit from patent foramen ovale closure. The data overall do not exclude the possibility of a placebo effect for resolving migraine following patent foramen ovale closure. CONCLUSION This systematic review demonstrates firstly that migraine headache attack is associated with a higher prevalence of patent foramen ovale than among the general population. Observational data suggest that some improvement of migraine would be observed if the patent foramen ovale were to be closed. A proper assessment of any interventions for patent foramen ovale closure would require further large randomized trials to be conducted given uncertainties from existing trial data.
Collapse
Affiliation(s)
- Philomena Z Y Lip
- Department of Cardiovascular Medicine, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Gregory Y H Lip
- Department of Cardiovascular Medicine, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
| |
Collapse
|
5
|
Menon SC, Grove A, McFadden M, Korgenski KE, Cowley CG. Clinical practice, resource utilization, and outcomes of device closure of patent foramen ovale in pediatrics. Pediatr Neurol 2014; 50:213-7. [PMID: 24433855 DOI: 10.1016/j.pediatrneurol.2013.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 11/01/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are few data on patent foramen ovale closure and its outcome in children. In this study, we evaluated the current clinical practice, resource utilization, and outcome of device closure of patent foramen ovale in children. We hypothesized that patent foramen ovale closure would not result in a demonstrated benefit in children. METHODS We undertook a prospective survey of all consecutive patients (<20 years) who underwent patent foramen ovale closure in our metropolitan area between 1995 and 2010. Differences in proportions were tested using the chi-square test or Fisher's exact test where appropriate. Differences in group medians were tested using Wilcoxon signed-rank test. RESULTS A total of 153 patients (104 girls), median age 16 years (range 7-19) were studied. Indications for patent foramen ovale closure included: (1) migraine headache (104; 68%), (2) nonmigraine headache (24; 16%), (3) visual symptoms (110; 72%), (4) transient ischemic attack symptoms (42; 28%), and (5) stroke-like symptom (24; 16%). Patent foramen ovale was closed with an Amplatzer septal occluder in 115 (75%) and a Helex septal occluder in 47 (30%). The mean length of hospital stay was 18 ± 11 hours; the mean hospital charge was $24,126 ± $5808. The median duration of follow-up was 12 months, and 80 patients responded to the study survey. On follow-up, symptoms improved in 143 (93%), of which 29 (19%) had a residual shunt. None of the patient or treatment parameters predicted lack of improvement on follow-up. CONCLUSIONS Despite the lack of proven benefit, children undergo closure of the patent foramen ovale for a variety of reasons, with the vast majority (92%) of patients reporting significant improvement in their symptoms. However, patent foramen ovale closure is an expensive procedure with serious potential complications. Symptomatic improvement even in the presence of a residual shunt suggests a strong placebo effect.
Collapse
Affiliation(s)
- Shaji C Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah.
| | - Amanda Grove
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
| | - Molly McFadden
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Kent E Korgenski
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Collin G Cowley
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
| |
Collapse
|
6
|
Roy D, Sharma R, Bunce N, Ward D, Brecker SJ. Selecting the optimal closure device in patients with atrial septal defects and patent foramen ovale. Interv Cardiol 2012. [DOI: 10.2217/ica.11.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
7
|
Kitsios GD, Dahabreh IJ, Abu Dabrh AM, Thaler DE, Kent DM. Patent foramen ovale closure and medical treatments for secondary stroke prevention: a systematic review of observational and randomized evidence. Stroke 2011; 43:422-31. [PMID: 22180252 DOI: 10.1161/strokeaha.111.631648] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Patients discovered to have a patent foramen ovale in the setting of a cryptogenic stroke may be treated with percutaneous closure, antiplatelet therapy, or anticoagulants. A recent randomized trial (CLOSURE I) did not detect any benefit of closure over medical treatment alone; the optimal medical therapy is also unknown. We synthesized the available evidence on secondary stroke prevention in patients with patent foramen ovale and cryptogenic stroke. METHODS A MEDLINE search was performed for finding longitudinal studies investigating medical treatment or closure, meta-analysis of incidence rates (IR), and IR ratios of recurrent cerebrovascular events. RESULTS Fifty-two single-arm studies and 7 comparative nonrandomized studies and the CLOSURE I trial were reviewed. The summary IR of recurrent stroke was 0.36 events (95% confidence interval [CI], 0.24-0.56) per 100 person-years with closure versus 2.53 events (95% CI, 1.91-3.35) per 100 person-years with medical therapy. In comparative observational studies, closure was superior to medical therapy (IR ratio=0.19; 95% CI, 0.07-0.54). The IR for the closure arm of the CLOSURE I trial was higher than the summary estimate from observational studies; there was no significant benefit of closure over medical treatment (P=0.002 comparing efficacy estimates between observational studies and the trial). Observational and randomized data (9 studies) comparing medical therapies were consistent and suggested that anticoagulants are superior to antiplatelets for preventing stroke recurrence (IR ratio=0.42; 95% CI, 0.18-0.98). CONCLUSIONS Although further randomized trial data are needed to precisely determine the effects of closure on stroke recurrence, the results of CLOSURE I challenge the credibility of a substantial body of observational evidence strongly favoring mechanical closure over medical therapy.
Collapse
Affiliation(s)
- Georgios D Kitsios
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA
| | | | | | | | | |
Collapse
|
8
|
McCandless RT, Arrington CB, Nielsen DC, Bale JF, Minich LL. Patent foramen ovale in children with migraine headaches. J Pediatr 2011; 159:243-7.e1. [PMID: 21450305 DOI: 10.1016/j.jpeds.2011.01.062] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 12/16/2010] [Accepted: 01/28/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the prevalence of patent foramen ovale (PFO) in children with migraine. STUDY DESIGN Children aged 6.0 to 18.0 years with migraine headache were evaluated for PFO and right-to-left shunting with color-flow Doppler scanning, saline solution contrast transthoracic echocardiography, and contrast transcranial Doppler scanning. RESULTS The population consisted of 109 children with migraine; 38 (35%) with aura and 71 (65%) without aura. The overall PFO prevalence was 35%, similar to the general population (35% vs 25%; P = .13). However, compared with the general population (25%), the PFO prevalence was significantly greater in subjects with aura (50%, P = .0004) but similar in those without aura (27%, P = .73). Atrial shunt size was not associated with the presence or absence of aura. CONCLUSION Children with migraine with aura have a significantly higher prevalence of PFO compared with those without aura or the general population. These data suggest that PFO may contribute to the pathogenesis of migraine with aura in children and have implications for clinical decision making.
Collapse
Affiliation(s)
- Rachel T McCandless
- Division of Cardiology, Department of Pediatrics, Primary Children's Medical Center and the University of Utah, Salt Lake City, UT, USA.
| | | | | | | | | |
Collapse
|
9
|
Zhang CJ, Huang YG, Huang XS, Huang T, Huang WH, Shen JJ. Transcatheter Closure of Patent Foramen Ovale in Chinese Patients With Paradoxical Embolism - Immediate Results and Long-Term Follow-up -. Circ J 2011; 75:1867-71. [DOI: 10.1253/circj.cj-11-0068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Cao-jin Zhang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute
| | - Yi-gao Huang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute
| | - Xin-sheng Huang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute
| | - Tao Huang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute
| | - Wen-hui Huang
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute
| | - Jun-jun Shen
- Department of Cardiology, Guangdong General Hospital & Guangdong Cardiovascular Institute
| |
Collapse
|
10
|
Bronzetti G, D'Angelo C, Donti A, Salomone L, Giardini A, Maria Picchio F, Boriani G. Role of atrial fibrillation after transcatheter closure of patent foramen ovale in patients with or without cryptogenic stroke. Int J Cardiol 2011; 146:17-21. [DOI: 10.1016/j.ijcard.2009.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 05/11/2009] [Indexed: 11/26/2022]
|
11
|
Butera G, Biondi-Zoccai GGL, Carminati M, Caputi L, Usai S, Bussone G, Meola G, Delogu AB, Sheiban I, Sangiorgi G. Systematic review and meta-analysis of currently available clinical evidence on migraine and patent foramen ovale percutaneous closure: much ado about nothing? Catheter Cardiovasc Interv 2010; 75:494-504. [PMID: 20088014 DOI: 10.1002/ccd.22232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the role of transcatheter closure of patent foramen ovale on the occurrence of migraine. BACKGROUND In recent years, a potential relationship between, migraine, stroke, and patent foramen ovale (PFO) has emerged. METHODS BioMedCentral, Google Scholar, and PubMed from January 2000 to December 2008 were systematically searched for pertinent clinical studies. Secondary sources were also used. Secondary prevention studies of transcatheter closure for patent foramen ovale were required to include at least more than 10 patients followed for more than 6 months. The primary end-point was the rate of cured or significantly improved migraine after percutaneous PFO closure. RESULTS After excluding 637 citations, we finally included a total of 11 studies for a total of 1,306 patients. Forty percent of the subjects included suffered from migraine, while most had a previous history of transient ischemic attack/stroke and were investigated retrospectively. Quantitative synthesis showed that complete cure of migraine in 46% (95% C.I.25-67%), while resolution or significant improvement of migraine occurred in 83% (95% C.I. 78-88%) of cases. CONCLUSIONS Notwithstanding the limitations inherent in the primary studies, this systematic review suggests that a significant group of subjects with migraine, in particular if treated after a neurological event, may benefit from percutaneous closure of their patent foramen ovale. However, many questions remain unsolved.
Collapse
Affiliation(s)
- Gianfranco Butera
- Department of Pediatric Cardiology and GUCH unit, Policlinico San Donato, IRCCS, San Donato Milanese, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Tepper SJ, Cleves C, Taylor FR. Patent foramen ovale and migraine: Association, causation, and implications of clinical trials. Curr Pain Headache Rep 2009; 13:221-6. [DOI: 10.1007/s11916-009-0037-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
Cifarelli A, Musto C, Parma A, Pandolfi C, Pucci E, Fiorilli R, De Felice F, Nazzaro MS, Violini R. Long-term outcome of transcatheter patent foramen ovale closure in patients with paradoxical embolism. Int J Cardiol 2009; 141:304-10. [PMID: 19178959 DOI: 10.1016/j.ijcard.2008.12.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 11/20/2008] [Accepted: 12/05/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Optimal management of patients with PFO and paradoxical embolic events is still debated. Moreover, data from long-term studies on large patient populations are lacking. Aim of the study is to assess immediate and long-term clinical outcome of patients with PFO and paradoxical thrombo-embolic events submitted to transcatheter PFO closure. METHODS Only patients with PFO-related transient ischemic attack or stroke underwent PFO closure. Patients were evaluated clinically and echocardiographically at 1, 6 and 12 months after the procedure and yearly thereafter. Primary endpoints were death, recurrent stroke or TIA. Residual right-to left shunt (RLS) was monitored by transthoracic echocardiography (TTE) or transcranial Doppler (TCD) at 6 months'follow-up. RESULTS 202 consecutive patients underwent percutaneous PFO closure for secondary prevention of TE. Device migration was observed in one patient 24 h after the procedure. No cases of procedure-related death or stroke occurred during a median follow-up of 3+/-1.3 years. Three recurrent TIAs were observed within the first 6 months of follow-up. The cumulative estimated probability of recurrent TE-free survival rate after PFO closure was 99% in patients <or=55 years, 84% in patients >55 years (p<0.05) and 94% and 100% in patients with PFO, with or without atrial septal aneurysm (ASA), respectively (p<0.05). Of the 188 (93%) patients submitted to TTE or TCD at 6 months' follow-up, 8 (4%) presented a small RLS. CONCLUSION Transcatheter PFO closure is associated with low incidence of in-hospital complications and low frequency of recurrent TE at long-term follow-up.
Collapse
Affiliation(s)
- Alberta Cifarelli
- Interventional Cardiology Unit, S Camillo/Forlanini Hospital, Circonvallazione Gianicolense 87, 00151 Rome, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Rigatelli G. Migraine and patent foramen ovale: connecting flight or one-way ticket? Expert Rev Neurother 2008; 8:1331-7. [PMID: 18759545 DOI: 10.1586/14737175.8.9.1331] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT The genesis of migraine in patients with patent foramen ovale (PFO) and its relationship with paradoxical stroke is still debated. Some authors agree that migraine with aura and PFO have higher coincidences than would be expected by chance and that it is possible that both conditions are inherited together. OBJECTIVE The present review aims to make a comprehensive attempt at clarifying the PFO-migraine connection in light of recent evidence from literature. EVIDENCE ACQUISITION A Medline search using both OVID and PubMed was performed by searching for literature in English regarding randomized trials, prospective cohort studies, meta-analyses, reviews and editorials about PFO and migraine between 1998 and 2008. Search key words were 'migraine' and 'patent foramen ovale' matched with 'prevalence', 'echocardiography', 'transcranial Doppler ultrasound', 'magnetic resonance imaging', 'coagulation abnormalities' and 'transcatheter closure treatment'. Additional reference material was obtained from the proceedings of relevant conferences on PFO and migraine, and the author's personal experience. EVIDENCE SYNTHESIS Echocardiographic, transcranial Doppler and MRI studies suggest that migraine patients are at higher risk of stroke compared with the normal population and often have white matter brain lesions on MRI. A large proportion of PFO patients have migraine, in particular migraine with aura, and migraine with aura patients plus PFO have larger shunts compared with migraine-free patients. It has been suggested that patients with migraine and large PFO have an increased risk of paradoxical embolism. Most patients with PFO and migraine respond well to transcatheter closure and this fact is unlikely to be caused just by a placebo effect. CONCLUSIONS Although many gray areas are still present, migraine with aura and large PFO seem to be strictly related to both anatomic and functional states at least in a proportion of patients.
Collapse
Affiliation(s)
- Gianluca Rigatelli
- Adult Congenital Heart Disease, Cardiovascular Diagnosis & Endoluminal Interventions, Roligo General Hospital, Roligo, Italy.
| |
Collapse
|
15
|
Abstract
OBJECTIVE The purpose of this article is to review the latest concepts regarding migraine and ischemic stroke. In addition, focal neurological deficits and MRI changes in migraine patients will be reviewed. METHODS A PubMed search of neurological literature pertaining to this study was conducted using specific keyword search terms pertaining to migraine and ischemic stroke. RESULTS Migraine, especially with aura, is a relative risk factor for stroke. Neuroimaging demonstrates the posterior circulation as being most vulnerable, although the reason for this distribution is unclear. Factors that may contribute to stroke in migraine include changes during cortical spreading depression with hyper- or hypoperfusion of neural tissue, vasospasm and endothelial dysfunction. Estrogen affects migraine expression as well as cerebral circulation, yet most women with migraine without aura are not at increased risk. Co-morbidity with patent foramen ovale can be mechanism of both disorders via presumed lack of filtration of microemboli or toxic substances; however, closure with reversal of right to left shunt seems to be more beneficial for cryptogenic stroke than migraine. Migraine and stroke are found in specific genetic disorders such as CADASIL, HERNS and MELAS giving clues to genetic factors. Stroke associated with migraine treatments such as ergots or triptans is rare, and usually associated with special circumstances such as overuse or concomitant thrombogenic conditions. CONCLUSION Although true migrainous infarction is rare, our understanding of the subtle associations between migraine and cerebrovascular behavior is expanding.
Collapse
Affiliation(s)
- Debra Elliott
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA 71130-3932, USA.
| |
Collapse
|
16
|
Martínez-Sánchez P, Fuentes Gimeno B, Oliver Ruiz JM, Ángeles Ortega-Casarrubios M, Idrovo Freire L, Díez-Tejedor E. Migraña y alteraciones del septo auricular en pacientes menores de 55 años con infarto cerebral criptogenético. Med Clin (Barc) 2008; 131:521-5. [DOI: 10.1157/13127576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
17
|
D’Amico D, Usai S, Caputi L, Bussone G. Does closure of a patent foramen ovale have a role in the treatment of migraine with aura? Neurol Sci 2008; 29 Suppl 1:S23-7. [DOI: 10.1007/s10072-008-0880-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Butera G, Agostoni E, Biondi-Zoccai G, Bresolin N, Fumagalli L, Chessa M, Gallanti A, Scacciatela P, Carminati M. Migraine, stroke and patent foramen ovale: a dangerous trio? J Cardiovasc Med (Hagerstown) 2008; 9:233-8. [PMID: 18301138 DOI: 10.2459/jcm.0b013e3282058912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
19
|
DUBIEL MARK, BRUCH LEONHARD, SCHMEHL INGO, LIEBNER MATTHIAS, WINKELMANN ANNE, STRETZ ANNA, GRAD MARCOLIVER, KLEBER FRANZXAVER. Migraine Headache Relief after Percutaneous Transcatheter Closure of Interatrial Communications. J Interv Cardiol 2008; 21:32-7. [DOI: 10.1111/j.1540-8183.2007.00316.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
20
|
Burow A, Schwerzmann M, Wallmann D, Tanner H, Sakata T, Windecker S, Meier B, Delacrétaz E. Atrial fibrillation following device closure of patent foramen ovale. Cardiology 2008; 111:47-50. [PMID: 18239392 DOI: 10.1159/000113427] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Recurrent embolic events after device closure of patent foramen ovale (PFO) have been related to incomplete closure. Another cause could be atrial fibrillation (AF). The aim of this study was to determine the incidence of AF in stroke patients after PFO closure. METHODS Consecutive patients with device closure of a PFO after a stroke or transient ischemic attack and control patients with stroke underwent 7-day event loop recordings 3 and 6 months after PFO closure or stroke, respectively. RESULTS Forty patients treated by PFO device closure 96 +/- 68 days after cryptogenic ischemic stroke and 70 control patients with ischemic stroke of other etiologies (known AF excluded) were compared. AF was identified in 6 patients (15%) of the treated group and in 12 control patients (17%, p = 0.77). In multivariate analysis, the presence of an occluder device was not an independent risk factor for AF. CONCLUSIONS The incidence of AF is high after device closure of a PFO in stroke patients and similar to that in patients with stroke of non-PFO etiology and, hence, with no device. Further studies are required to determine the risk of thromboembolism and the optimal treatment in patients developing AF after device closure of a PFO.
Collapse
Affiliation(s)
- Annika Burow
- Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Jesurum JT, Fuller CJ, Velez CA, Spencer MP, Krabill KA, Likosky WH, Gray WA, Olsen JV, Reisman M. Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal characteristics. J Headache Pain 2007; 8:209-16. [PMID: 17901924 PMCID: PMC3451677 DOI: 10.1007/s10194-007-0396-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 07/25/2007] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jill T Jesurum
- Department of Cardiovascular Research, Swedish Medical Center, Seattle, WA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Results from several observational studies indicate an association between migraine and patent foramen ovale (PFO). Several biological mechanisms have been proposed to explain this link, including shared genetic inheritance. However, there is currently insufficient evidence to support a causal link between PFO and migraine. Although the results of uncontrolled observational studies suggest the PFO closure may have a beneficial effect on migraine frequency, a large randomized trial failed to support such a conclusion. Until there is more evidence from ongoing large controlled trials, PFO closure should not be performed in clinical practice for the prophylaxis of migraine.
Collapse
Affiliation(s)
- Hans-Christoph Diener
- Department of Neurology, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
| | | | | |
Collapse
|
23
|
Diener HC, Kurth T, Dodick D. Patent foramen ovale, stroke, and cardiovascular disease in migraine. Curr Opin Neurol 2007; 20:310-9. [PMID: 17495626 DOI: 10.1097/wco.0b013e328136c22d] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW We will review the literature on the association between migraine with patent foramen ovale, stroke, and coronary heart disease. RECENT FINDINGS The prevalence of patent foramen ovale in patients with migraine with aura is significantly higher than in nonmigraine controls and migraineurs without aura. However, there is currently no evidence to support a causal relationship. Migraine with aura has been consistently associated with increased risk of ischemic stroke in several epidemiologic studies. Migraine with aura is associated with a more unfavourable cardiovascular risk profile and recent data suggest that the association between migraine with aura and stroke may extend to overall cardiovascular disease. Identification of migraine patients at particular risk for stroke or other vascular events is impossible based on current knowledge. SUMMARY Migraine with aura and patent foramen ovale have higher coincidences than expected by chance only. It is possible that both conditions are inherited together. Until now there has been no evidence from placebo-controlled randomized trials that closure of patent foramen ovale improves migraine with aura. There is increasing evidence that migraine with aura is not only a risk factor for ischemic stroke but also for myocardial infarction and other ischemic vascular events.
Collapse
|
24
|
Kimmelstiel C, Gange C, Thaler D. Is patent foramen ovale closure effective in reducing migraine symptoms? A controlled study. Catheter Cardiovasc Interv 2007; 69:740-6. [PMID: 17295330 DOI: 10.1002/ccd.21025] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We investigated the prevalence of migraine in patients with patent foramen ovale (PFO), and the effect of PFO closure on migraine symptoms and medications. BACKGROUND Studies have shown an association between migraine and PFO. Data have recently suggested a reduction in migraine symptoms following PFO closure. Most of these studies had no controls. METHODS Subjects were divided into three groups: No PFO (Controls, n = 65), PFO with no intervention ("Open PFO", n = 63), and PFO treated with percutaneous closure ("Closed PFO", n = 41). We measured the frequency, severity, and impact of migraine on quality of life employing MIDAS scores. Comparisons were made preceding and 90 days after either transesophageal echocardiography (Controls and "Open PFO") or PFO closure ("Closed PFO"). We compared the use of abortive medications between the two time points. RESULTS Migraine, especially with aura, was more prevalent in both PFO groups (P < 0.05). Migraine frequency was reduced by 83% in Closed PFO compared with 0% of Open PFO and 10% of control patients (P < 0.0001). Migraine severity and MIDAS scores were reduced by PFO closure when compared to the other two groups (P < 0.0001, P = 0.035 respectively). Reduction in abortive medications was noted in 71% after closure, 5% of Open PFO, and 10% of Controls (P < 0.001). CONCLUSIONS In this controlled study, migraine, especially with aura, is more frequent in subjects with PFO. PFO closure is associated with a reduction in migraine frequency and severity, as well as an improvement in MIDAS scores. PFO closure was associated with a significant reduction in the use of abortive medications.
Collapse
Affiliation(s)
- Carey Kimmelstiel
- Cardiac Catheterization Laboratory, Division of Cardiology, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
| | | | | |
Collapse
|
25
|
Donti A, Giardini A, Salomone L, Formigari R, Picchio FM. Transcatheter patent foramen ovale closure using the premere PFO occlusion system. Catheter Cardiovasc Interv 2006; 68:736-40. [PMID: 17039524 DOI: 10.1002/ccd.20845] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy profile of the new Premere patent foramen ovale (PFO) occlusion system. BACKGROUND Several different devices have been used so far for transcatheter PFO closure but no data has been published so far on the efficacy and safety of the Premere PFO occlusion system. METHODS Since September 2005, 15 patients (seven males, eight females; mean age 51.2 +/- 10.8 years) at our institution underwent transcatheter PFO closure because of cryptogenic stroke, using the Premere PFO occlusion system. The procedure was performed under fluoroscopic and transesophageal echocardiographic (TEE) guidance in all patients. Seven patients (47%) had an associated atrial septal aneurysm and two patients had had >1 stroke. Five patients (33%) had an associated thrombophilia, whereas three patients (20%) had a diagnosis of migraine headache with aura, by the referring neurologist. Residual shunt was assessed immediately after and 1 month (only in 11 patients) after the procedure by both transcranial Doppler and TEE. RESULTS Premere PFO devices could be implanted in all patients (20 mm size in seven patients, 25 mm size in eight). Fluoroscopy time was 7.3 +/- 1.9 and procedural time was 11 +/- 3 min (range 7-17 min), reflecting our initial learning curve with this device. No complication occurred during the procedure or at follow-up. A residual shunt was noted immediately after the procedure in eight patients (53%) and at 1 month in 4/11 patients (36%). Residual shunt was mild in all patients. After a median follow-up of 4.2 months (0.2-5.8 months), no patient had a recurrent stroke. All patients with migraine headache with aura had resolution of symptoms. CONCLUSIONS Our preliminary experience with the Premere PFO occlusion system shows that this device is safe and effective.
Collapse
Affiliation(s)
- Andrea Donti
- Pediatric Cardiology and Adult Congenital Unit, Institute of Cardiology, University of Bologna, Italy
| | | | | | | | | |
Collapse
|