ABSTRACT 3

Improvement in Migraine Symptoms After Transcutaneous Closure of Patent Foramen Ovale for Recurrent Stroke  CIRCULATION 2004; 10: III440


Sherman G Sorensen, Peter J Casterella, LDS Hospital, Salt Lake City, UT; Joseph B Muhlestein, LDS Hospital, University of Utah, Salt Lake City, UT; Malinda Gillespie, Laurie Raleigh, Tami L Bair, Qunyu Li, Brianna S Ronnow, Robert R Pearson, Heath U Jones, Donald L Lappé, LDS Hospital, Salt Lake City, UT

Background: Migraine headache (MH) is a common, sometimes disabling disorder of unknown cause. Recent studies linking patent foramen ovale (PFO) to stroke have also proposed a link between MH and PFO. Transcatheter PFO closure (PFO-C) is a new percutaneous therapy for PFO-associated stroke. Whether this therapy has any effect on MH in these patients (pts) is not known.

Methods: A total of 200 consecutive pts undergoing PFO-C for recurrent stroke were surveyed regarding a potential history of MH before and after their procedure and 121 (61%) responded. Evaluation was performed using a standardized migraine severity index (M-SI)(score range = 0-10) and a subjective response questionnaire asking whether MH symptoms were gone, better, the same, or worse.

Results: Of responding patients 59(49%) received the CardioSealTM and 62(51%) received the AmplatzerTM PFO-C devices respectively. Of these, 69(57%) had MH before PFO-C (age = 45±14 yrs, female = 70%) and 52(43%) (age = 54±14 yrs, female = 55%) did not. Follow-up after PFO-C was: median 129 (range 63-450) days. Of the 69 patients with pre-procedural MH, 30 (44%), 27(37%), 8(12%), and 4(6%) reported symptoms were gone, better, the same and worse respectively. Likewise, the M-SI score was significantly lower post- compared to pre-procedure (2.5±3.0 versus 5.9±2.5, p<0.0001). Two patients reported developing MH for the first time after their PFO-C.

Conclusion: In this observational study of patients undergoing PFO-C for recurrent stroke, symptoms of migraine headaches were very common. Additionally, severity of migraine symptoms was significantly reduced after PFO-C and completely resolved in 44%. These findings may be clinically relevant and should be validated in future studies.