Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
Heart. 2010 Jun;96(12):967-73. doi: 10.1136/hrt.2009.181156.
Patent foramen ovale (PFO) has been linked to migraine, and an improvement in migraine prevalence or frequency has been reported after PFO closure for other reasons. We sought to identify whether there is a specific patient population of migraineurs which may be more susceptible to benefiting from PFO closure.
Retrospective cohort study.
Tertiary care centre. Participants 603 consecutive patients undergoing percutaneous PFO closure for secondary prevention of paradoxical embolism.
PFO closure using the Amplatzer PFO occluder.
Improvement of migraine symptoms.
150 patients (25%; aged 51+/-11 years) suffered from migraine, including 96 patients with migraine with aura. All implantation procedures were successful, without procedural complications. Contrast transoesophageal echocardiography at 6 months showed complete PFO closure in 136 patients (91%), whereas a minimal, moderate or large residual shunt persisted in 11 (7%), 2 (1%) or 1 (1%) patients, respectively. During 5.0+/-1.9 years of follow-up, one TIA and one ischaemic stroke occurred. Migraine headaches disappeared in 51 patients (34%) and improved in 72 additional patients (48%). Mean subjective improvement was 69+/-35%. Overall, mean headache frequency (from 2-3x/month to 1x/month; p<0.001), duration (from 4-72 to <4 h; p<0.001) and intensity (from 7+/-2 to 3+/-3; p<0.001) improved significantly. The prevalence of any migraine headaches (from 100% to 66%; p<0.001), migraine with aura (from 64% to 19%; p<0.001) and the number of patients taking any migraine medication (from 90% to 50%; p<0.001) decreased significantly. Both the presence of aura (OR 3.2; 95%CI 1.3 to 8.2; p=0.014) and high pain intensity at baseline (pain scale >5; OR 3.3; 95%CI 1.3 to 8.4; p=0.013) were independent predictors of response to PFO closure. A residual shunt had no influence on migraine improvement (OR 0.6; 95%CI 0.1 to 2.3; p=0.42).
These results suggest that percutaneous PFO closure durably alters the spontaneous course of shunt-associated migraine, especially but not exclusively in case of migraine with aura.
卵圆孔未闭（PFO）与偏头痛有关，并且已经报道了其他原因导致的 PFO 闭合后偏头痛的患病率或频率有所改善。我们试图确定是否存在更易受益于 PFO 闭合的偏头痛患者特定人群。
回顾性队列研究。
三级护理中心。参与者为 603 例连续接受经皮 PFO 闭合术以预防反常栓塞的患者。
使用 Amplatzer PFO 封堵器进行 PFO 闭合。
偏头痛症状的改善。
150 例患者（25%；年龄 51+/-11 岁）患有偏头痛，其中 96 例为有先兆偏头痛。所有植入手术均成功，无手术并发症。6 个月时的对比经食管超声心动图显示 136 例患者（91%）的 PFO 完全闭合，而 11 例（7%）、2 例（1%）和 1 例（1%）患者分别存在微小、中度或大量残余分流。在 5.0+/-1.9 年的随访期间，1 例出现 TIA 和 1 例缺血性卒中。51 例（34%）患者偏头痛消失，72 例（48%）患者偏头痛得到改善。平均主观改善率为 69+/-35%。总体而言，平均头痛频率（从 2-3 次/月降至 1 次/月；p<0.001）、持续时间（从 4-72 小时降至<4 小时；p<0.001）和强度（从 7+/-2 分降至 3+/-3 分；p<0.001）均显著改善。任何偏头痛发作的发生率（从 100%降至 66%；p<0.001）、有先兆偏头痛的发生率（从 64%降至 19%；p<0.001）和服用任何偏头痛药物的患者人数（从 90%降至 50%；p<0.001）均显著降低。先兆的存在（OR 3.2；95%CI 1.3 至 8.2；p=0.014）和基线时疼痛强度较高（疼痛量表>5；OR 3.3；95%CI 1.3 至 8.4；p=0.013）是对 PFO 闭合有反应的独立预测因素。残余分流对偏头痛的改善没有影响（OR 0.6；95%CI 0.1 至 2.3；p=0.42）。
这些结果表明，经皮 PFO 闭合可持久改变分流相关偏头痛的自然病程，尤其是但不限于有先兆偏头痛。
