PFO Closure and Migraine Study

Researchers have recently found out that patent foramen ovale (PFO) closure was safe and significantly reduced the mean number of monthly migraine days and monthly migraine attacks, as published in the Journal of American College of Cardiology.

Although observational studies have shown percutaneous patent foramen ovale (PFO) closure to be a safe means of reducing the frequency and duration of migraine, randomized clinical trials have not met their primary efficacy endpoints.

Hence, Mohammad K. Mojadidi and colleagues from the Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA conducted pooled analysis of individual participant data from the 2 randomized trials using the Amplatzer PFO Occluder to assess the efficacy and safety of the percutaneous device closure as a therapy for episodic migraine with or without aura.

The authors analyzed individual patient-level data from 2 randomized migraine trials (the PRIMA [Percutaneous Closure of Patent Foramen Ovale in Migraine With Aura] and PREMIUM [Prospective Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects with Migraine and PFO Using the Amplatzer PFO Occluder Compared to Medical Management] studies). Efficacy endpoints were mean reduction in monthly migraine days, responder rate (defined as ≥50% reduction in monthly migraine attacks), mean reduction in monthly migraine attacks, and percentage of patients who experienced complete cessation of migraine. The safety endpoint was major procedure- and device-related adverse events.

A total of 337 subjects were included in the trial, out of which 176 were randomized by blocks to device closure and 161 to medical treatment only.

Outcomes

• At 12-month follow-up, the analysis met 3 of the 4 efficacy endpoints:
  • Mean reduction of monthly migraine days (−3.1 days vs. −1.9 days; p = 0.02)
  • Mean reduction of monthly migraine attacks (−2.0 vs. −1.4; p = 0.01)
  • Number of subjects who experienced complete cessation of migraine (14 [9%] vs. 1 [0.7%]; p < 0.001)
• For the safety analysis, 9 procedure-related and 4 device-related adverse events occurred in 245 subjects who eventually received devices.
• All events were transient and resolved.

Therefore, the authors concluded that "PFO closure was safe and significantly reduced the mean number of monthly migraine days and monthly migraine attacks, and resulted in a greater number of subjects who experienced complete migraine cessation."