Purpose: Patent foramen ovale (PFO) closure is sometimes considered for patients (pts) with migraine. In our institution the therapeutic choice is the result of an interplay between the opinion of the neurologist, the cardiologist and the patient's preference. We sought to evaluate the impact on quality of life of pts with migraine who underwent PFO closure vs medical therapy alone. Methods: From December 1997 to June 2012, 217 migraine pts were referred for evaluation of PFO closure. The MIDAS questionnaire, used to evaluate the impact of migraine on quality of life, was obtained in all pts at baseline and repeated at least 3 months after the first evaluation or trans-catheter closure of PFO. Moreover a subjective evaluation was obtained asking the patients if they felt better, worse or the same as at the time of the index evaluation. Trans-catheter PFO closure was performed in 89 pts (Group A), while the remaining 128 (Group B) went on with medical therapy. Results: Mean age did not differ (Group A 46,4±12,7; Group B 47,1±12,3, p=0,684); female were more frequent in group B (Group A 22M/67 F; Group B 12M/ 118F, p=0,003). Baseline MIDAS score was similar (Group A 47,5±66,3; Group B 46,1±49,6, p=0.859). All procedures were successful and free of complications. At a mean follow up of 1388–±990 days, both groups had a significant reduction of MIDAS score (Group A 17,2±33,8 p< 0,001 vs baseline; Group B 26,3±38,2, p<0,001 vs baseline), but no significant differences between groups were found (p= 0,204). In detail, PFO closure did not significantly reduce missed days of work/3 months (Group A 1,8±6,4, Group B 2,0±4,8 days; p=0,792) or days of missed family or leisure activities (Group A 4,1±9,8, Group B 5,9±12,1 days; p= 0,246), but resulted in reduction of the number of days with headache (Group A 10,2±18,9, Group B 20,0±24,8 days/3 months; p=0,002) and of the intensity of pain evaluated on a 0 to 10 scale (Group A 4,4±3,7, Group B 7,0±8,2; p=0,005). At variance with the results of MIDAS score, a subjective improvement of migraine was reported by more pts in Group A, than in Group B (74, 83,1% vs 66, 51,5%; p<0,001). Conclusion: As the aim of migraine therapy is the perceived improvement of symptoms, one wonders whether the method of evaluation should be more adherent to the patient's perception. In our population, PFO closure was perceived as beneficial by the patients, but this benefit did not translate in a significantly improved MIDAS score.
Evolution of migraine after trans-catheter closure of patent forame ovale
BIASCO, LUIGI;VICENTINI, Silvia;LONGO, Giada;ROVERA, Chiara;ORZAN, Fulvio;GAITA, Fiorenzo
2013-01-01
Abstract
Purpose: Patent foramen ovale (PFO) closure is sometimes considered for patients (pts) with migraine. In our institution the therapeutic choice is the result of an interplay between the opinion of the neurologist, the cardiologist and the patient's preference. We sought to evaluate the impact on quality of life of pts with migraine who underwent PFO closure vs medical therapy alone. Methods: From December 1997 to June 2012, 217 migraine pts were referred for evaluation of PFO closure. The MIDAS questionnaire, used to evaluate the impact of migraine on quality of life, was obtained in all pts at baseline and repeated at least 3 months after the first evaluation or trans-catheter closure of PFO. Moreover a subjective evaluation was obtained asking the patients if they felt better, worse or the same as at the time of the index evaluation. Trans-catheter PFO closure was performed in 89 pts (Group A), while the remaining 128 (Group B) went on with medical therapy. Results: Mean age did not differ (Group A 46,4±12,7; Group B 47,1±12,3, p=0,684); female were more frequent in group B (Group A 22M/67 F; Group B 12M/ 118F, p=0,003). Baseline MIDAS score was similar (Group A 47,5±66,3; Group B 46,1±49,6, p=0.859). All procedures were successful and free of complications. At a mean follow up of 1388–±990 days, both groups had a significant reduction of MIDAS score (Group A 17,2±33,8 p< 0,001 vs baseline; Group B 26,3±38,2, p<0,001 vs baseline), but no significant differences between groups were found (p= 0,204). In detail, PFO closure did not significantly reduce missed days of work/3 months (Group A 1,8±6,4, Group B 2,0±4,8 days; p=0,792) or days of missed family or leisure activities (Group A 4,1±9,8, Group B 5,9±12,1 days; p= 0,246), but resulted in reduction of the number of days with headache (Group A 10,2±18,9, Group B 20,0±24,8 days/3 months; p=0,002) and of the intensity of pain evaluated on a 0 to 10 scale (Group A 4,4±3,7, Group B 7,0±8,2; p=0,005). At variance with the results of MIDAS score, a subjective improvement of migraine was reported by more pts in Group A, than in Group B (74, 83,1% vs 66, 51,5%; p<0,001). Conclusion: As the aim of migraine therapy is the perceived improvement of symptoms, one wonders whether the method of evaluation should be more adherent to the patient's perception. In our population, PFO closure was perceived as beneficial by the patients, but this benefit did not translate in a significantly improved MIDAS score.
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