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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
10:52

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

Published on: December 23, 2022

The patent foramen ovale-migraine question

S J Tepper1, F D Sheftell, M E Bigal

  • 1The New England Center for Headache, 778 Long Ridge Road, Stamford, CT 06902, USA. sjtepper@aol.com

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|May 18, 2007
PubMed

Insights

Patent foramen ovale (PFO) closure may reduce migraine with aura days. While one study didn't meet its primary goal, it showed a significant reduction in migraine frequency, suggesting further research is needed.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Patent foramen ovale (PFO) is associated with migraine with aura.
  • PFOs are also linked to conditions like cryptogenic strokes and hypoxemia.
  • Pulmonary arteriovenous malformations in Osler-Weber-Rendu disease may also contribute to migraine with aura.

Purpose of the Study:

  • To evaluate the efficacy of PFO closure in patients with migraine with aura.
  • To investigate the relationship between PFO shunt severity and migraine with aura.

Main Methods:

  • Review of open-label, retrospective, and case-controlled studies on PFO closure for migraine with aura.
  • Analysis of the MIST trial, a prospective, sham-controlled study on PFO closure for migraine with aura.

Main Results:

  • Multiple observational studies suggest PFO closure improves migraine with aura.
  • The MIST trial did not meet its primary endpoint for migraine resolution but showed a significant association between PFO shunt severity and migraine with aura.
  • A secondary endpoint in the MIST trial indicated a 42% reduction in migraine days.

Conclusions:

  • While definitive evidence is pending, PFO closure shows promise for reducing migraine with aura frequency.
  • Further randomized, sham-controlled trials are warranted to confirm the benefits of PFO closure for migraine with aura.

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