Effect of Residual Interatrial Shunt on Migraine Burden After Transcatheter Closure of Patent Foramen Ovale

Many studies reported improvement in migraine symptoms after patent foramen ovale (PFO) closure, yet randomized trials failed to reach its clinical endpoints. We evaluated the long-term effect of transcatheter PFO closure on migraineurs with and without aura, and to examine the effect of residual right-to-left shunt.

We retrospectively analyzed data from 474 patients who underwent transcatheter PFO closure at Massachusetts General Hospital. Patients completed a migraine burden questionnaire at baseline and at follow-up. Migraine severity is reported as migraine frequency (days/month), average duration (minutes), and migraine burden (days*minutes/month). Improvement was defined as complete abolishment of symptoms or > 50% reduction in migraine burden.

110 migraineurs who underwent PFO closure were included. 77% had aura and 23% without aura. 91% had a cryptogenic stroke. During long-term median follow-up of 3.2 (2.1- 4.9) years there was a significant improvement in migraine symptoms in migraineurs with or without aura. Migraine burden was reduced by > 50% in 87% of patients, and symptoms were completely abolished in 48%. Presence of aura was associated with abolishment of migraine (OR 4.3 [95% CI 1.5-12.3]; p=0.006). At 6 months after PFO closure, residual right-to-left shunt was present in 26% of patients. Absence of right-to-left shunt was associated with improvement in migraine burden by > 50% (OR 4.6 [95% CI 1.3-16.1]; p=0.017).

Long-term follow up after transcatheter PFO closure was associated with significant improvement in migraine burden. Aura was a predictor of abolishing symptoms. Absence of residual right-to-left shunt was a predictor of significant reduction in migraine burden.