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Updated: May 26, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Transcatheter Patent Foramen Ovale Closure and Complete Remission of Migraine in Children: A Single-Center
Changjian Li1, Qing Lu2, Yong Zhang3
1Department of Cardiology, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital, Huazhong University of Science and Technology, Wuhan, 430016, China.
Insights
Transcatheter patent foramen ovale (PFO) closure significantly improved migraine remission in children with shunts. PFO closure offers a promising treatment avenue for pediatric migraine management.
Area of Science:
- Cardiology
- Neurology
- Pediatrics
Background:
- Patent foramen ovale (PFO) is a common cardiac defect associated with migraines.
- Right-to-left shunting (RLS) through a PFO may contribute to migraine pathophysiology in children.
- Evaluating PFO closure as a treatment for pediatric migraine is crucial.
Purpose of the Study:
- To assess the association between transcatheter PFO closure and complete migraine remission in pediatric patients.
- To compare remission rates in children with migraine and PFO undergoing closure versus medical management.
Main Methods:
- Retrospective cohort study of 66 children with migraine and PFO-mediated RLS.
- Primary exposure: transcatheter PFO closure.
- Primary outcome: complete migraine remission (≥3 months) assessed at 1, 3, 6, and 12 months post-discharge.
Main Results:
- Complete migraine remission within 12 months was achieved by 89.5% of PFO closure patients versus 42.6% of non-closure patients (p=0.002).
- Adjusted Cox regression showed PFO closure was associated with remission (HR 3.60; p=0.009), persisting after RLS stratification.
- A graded remission pattern was observed: no treatment (34.4%), flunarizine (60.0%), and PFO closure (89.5%).
Conclusions:
- Transcatheter PFO closure is associated with significantly higher rates of complete migraine remission in children with migraine and RLS.
- Findings are hypothesis-generating, suggesting PFO closure as a potential therapeutic option for pediatric migraine.
- Further prospective randomized studies are warranted to confirm these findings and guide clinical recommendations.
Abstract:
To evaluate whether transcatheter patent foramen ovale (PFO) closure is associated with higher rates of complete migraine remission in children with migraine and a concomitant right-to-left shunt. We conducted a single-center retrospective cohort study of children with migraine and PFO-mediated right-to-left shunting. The primary exposure was transcatheter PFO closure; the primary outcome was complete migraine remission (no attacks for ≥ 3 consecutive months) assessed at 1, 3, 6, and 12 months post-discharge. Kaplan-Meier and multivariable Cox regression with a 3-month landmark were adjusted for right-to-left shunt (RLS) grade, age, sex, duration of the current headache episode, body mass index, and concomitant flunarizine prophylaxis. Among 66 children (mean age 10.3 years; 67% male), 19 underwent transcatheter PFO closure, and 47 received medical management. Complete migraine remission within 12 months occurred in 17/19 (89.5%) of closure patients versus 20/47 (42.6%) of non-closure patients (log-rank p = 0.002). In the adjusted Cox model, closure was associated with remission (hazard ratio [HR] 3.60, 95% confidence interval [CI] 1.38-9.42, p = 0.009); the association persisted after stratification for RLS (HR 3.18, 95% CI 1.26-8.04). A graded pattern was observed across three strata: no treatment 34.4%, flunarizine 60.0%, closure 89.5% (Kendall τ = 0.45, p < 0.001). All 19 procedures achieved complete closure without complications. Transcatheter PFO closure was associated with higher rates of complete migraine remission after adjustment for shunt grade, prophylaxis, and other covariates. Findings are hypothesis-generating; prospective randomized studies are needed before closure can be recommended for pediatric migraine outside clinical trials.
