Impact of percutaneous patent foramen ovale closure on migraine headaches in patients with history of ischemic neurological events

Introduction
Observational studies have shown that migraine has been associated with patent foramen ovale (PFO). Whilst studies investigating PFO closure for the treatment of migraine have been neutral, there is some evidence that symptoms of migraine may improve if the PFO was closed after ischemic stroke.

Aim
To establish whether closure of PFO in patients with stroke or transient ischemic attack (TIA) is associated with reduction in the severity of co-existent migraine headaches.

Material and methods
Patients with ischemic stroke or TIA, PFO suitable for percutaneous closure and migraine, were given migraine severity questionnaires prior to PFO closure. These were followed up at 6 and 12 months after closure with the same questionnaire. The primary endpoint was change in migraine severity using the Migraine Severity Scale (MIGSEV). Migraine episode frequency, disability (using the MIDAS scale), and pain intensity were also assessed.

Results
Sixty-two patients were included in the analysis. MIGSEV scores reduced from 7 (7–8) at baseline to 4 (3.25–6) at 6-month follow-up, and 3 (0–4) at 12-month follow-up (p < 0.001). Other measures of migraine headache were also improved at both 6- and 12-month follow-up. Twenty-four (38%) patients were rendered migraine free at 12 months.

Conclusions
PFO closure for stroke or TIA prevention in patients with migraine was associated with a reduction in markers of migraine headache severity.