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Updated: Jun 4, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Sustained long-term benefit of patent foramen ovale closure on migraine
Daniela Trabattoni1, Franco Fabbiocchi, Piero Montorsi
1Centro Cardiologico Monzino, Department of Cardiovascular Sciences, University of Milan, Milan, Italy. daniela.trabattoni@ccfm.it
Objectives:
This single-center, observational, prospective study evaluated the impact of patent foramen ovale (PFO) closure on migraine attacks over time.
Background:
PFO closure may reduce the frequency and severity of migraine headaches in patients with significant right-to-left shunts.
Methods:
Between May 2000 and September 2009, 305 consecutive patients (mean age, 43 ± 12 years; 54.5% women) with a prior embolic cerebrovascular event underwent PFO closure with the Amplatzer PFO occluder for recurrence prevention. All patients had right-to-left shunts; the shunts were associated with migraine symptoms in 77 (25%), either alone (n = 64, 83%) or with aura (n = 13, 17%). Septal aneurysm was present in 15 (19.5%) migraine patients, and 43 (56%) had a previous transient brain ischemic attack. All migraine patients had a computed tomography scan or magnetic resonance imaging, indicating a previous brain ischemic lesion. All 305 patients underwent transthoracic echocardiography with clinical follow-up at 24 hr, at 3, 6, and 12 months, and then yearly.
Results:
An acute migraine attack occurred 24-48 hr after PFO closure in 28 (36.4%) of 77 patients. There was a significant reduction (>50%) in the number and intensity of attacks in 46 (60.5%) of 77 patients at the 3-month follow-up. At the 12-month follow-up, migraine had ceased in 23 (46%) patients, and 20 (40%) had a reduction in the migraine recurrence rate and disabling symptoms. These results were maintained at follow-up (mean, 28 ± 27 months). There was overall improvement in migraine in 89% of the treated patients.
Conclusions:
Percutaneous PFO closure in migraineurs may provide beneficial mid-term and long-term results, with significant reduction in the intensity and frequency of headache symptoms.
Insights
Patent foramen ovale (PFO) closure significantly reduced migraine frequency and intensity in patients with PFO and a history of stroke. Most patients experienced sustained improvement in migraine symptoms at long-term follow-up.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Patent foramen ovale (PFO) is a potential contributor to cryptogenic stroke.
- PFO closure is an established treatment for stroke prevention in select patients.
- The impact of PFO closure on associated migraine symptoms is an area of ongoing research.
Purpose of the Study:
- To evaluate the efficacy of PFO closure in reducing migraine frequency and severity.
- To assess the long-term outcomes of PFO closure in patients experiencing migraines.
- To determine the correlation between PFO closure and migraine symptom improvement.
Main Methods:
- Observational, prospective study of 305 patients undergoing PFO closure for stroke prevention.
- Focus on a subgroup of 77 patients with PFO and migraine symptoms.
- Clinical follow-up included echocardiography at various intervals up to 12 months and yearly thereafter.
Main Results:
- Significant reduction (>50%) in migraine number and intensity observed in 60.5% of patients at 3 months.
- Migraine ceased in 46% and recurrence reduced in 40% by 12 months.
- Overall migraine improvement reported in 89% of treated patients, with sustained results at mean 28-month follow-up.
Conclusions:
- Percutaneous PFO closure demonstrates significant mid-term and long-term benefits for migraineurs.
- PFO closure can lead to a substantial decrease in headache intensity and frequency.
- This intervention offers a promising therapeutic option for patients with PFO-associated migraines.
