Abstract 20090: Transcatheter Patent Foramen Ovale Closure to Reduce Headache Burden in Patients with Migraine Headaches
Background: Patients (pts) that suffer from migraine headache (MH) often are moderate-severely disabled and have failed multiple therapies. In addition, a coexistent patent foramen ovale (PFO) is common and many pts have suffered a paradoxical cerebrovascular accident (CVA) or transient ischemic attack (TIA). We retrospectively reviewed our experience regarding PFO closure for these pts to assess the affect on headache burden.
Methods: Data for pts with MH that underwent PFO closure between January 2003 and January 2010 were reviewed. Inclusion required MH diagnosed by a neurologist, a 3-month headache burden by MIDAS (Migraine Disability Assessment) of Grade II to IV (mild-severe disability), a reported history of a least 3 failed MH treatments, and a right to left shunting PFO. The cohort was divided into three groups. The first group (MH-CVA) included pts with MH and a CVA, the second group (MH-TIA) included pts with MH and a TIA, and the third group (MH-alone) included pts with only MH. Procedures for PFO closure were performed using standard technique. All records were reviewed for procedural outcome, late adverse events, and headache burden.
Results: Our cohort included 84 pts with 28 MH-CVA, 30 MH-TIA, and 26 MH-alone. Median age was 34yrs (range: 17→47) and the mean balloon stop-flow diameter was 9±3mm (range: 5–18). Mean procedure and fluoroscopy times were 42±12min and 8±5min, respectively. There were no procedure-related adverse events. Overall, 6/84 pts (7.1%) had a residual leak at the 6 month follow-up with 3 pts returning for successful second occluder device placement. With an overall median follow-up of 32 months (range 5–76) there have been 5 pts with a non-focal event and 2 pts with atrial arrhythmia. Overall the mean MIDAS grade decreased significantly from 27.5±7.7 at baseline versus 2.7±3.4 at latest follow up, (p<0.001). Although there was no significant difference between the 3 subgroups there was a trend towards improvement in the MH-CVA subgroup (mean MIDAS grade 22±8.4 at baseline versus to 1.2±3.2).
Conclusions: These data indicate that device PFO closure is safe and effective in treating MH pts with a significant decrease in headache burden. This therapy should be considered an alternate when pharmacologic therapies have failed.
- © 2010 by American Heart Association, Inc.