Improvement of Migraine After Patent Foramen Ovale Percutaneous Closure in Patients With Subclinical Brain Lesions. A Case-Control Study

Objectives: We sought to evaluate the benefits on frequency and severity of migraine recurrence after patent foramen ovale (PFO) closure in patients with subclinical brain lesions at magnetic resonance imaging (MRI). Background: Migraine improvement has been reported after PFO closure in patients with cerebrovascular symptomatic events. Subclinical brain MRI lesions are detectable in patients with PFO and in migraineurs. Methods: A total of 82 patients with moderate/severe migraine, PFO, large right-to-left shunt, and subclinical brain MRI lesions were prospectively examined for a 6-month period. Patients were subdivided into closure (n = 53) and control (n = 29) group according to their consent to undergo percutaneous PFO closure. In controls, therapy for migraine was optimized. Six-month frequency and severity of migraine recurrence were compared with baseline. Results: The number of total attacks decreased more in the closure group (32 ± 9 to 7 ± 7, p <0.001) than in the control group (36 ± 13 to 30 ± 21, p = NS) (p <0.001). A significant reduction in disabling attacks was observed only in the closure group (20 ± 12 to 2 ± 2, p <0.001; controls: 15 ± 12 to 12 ± 12, p = NS). Migraine disappeared in 34% of the closure group patients and 7% of controls (p = 0.007); >50% reduction of attacks was reported by 87% and 21%, respectively (p <0.001). Disabling attacks disappeared in 53% of closure group patients and 7% of controls (p <0.001); >50% reduction occurred in 89% and 17%, respectively (p <0.001). Conclusions: In migraineurs with a large PFO and subclinical brain MRI lesions, a significant reduction in frequency and severity of migraine recurrence can be obtained by PFO closure when compared with frequency and severity in controls.