Meta-analysis of randomized trials on percutaneous patent foramen ovale closure for prevention of migraine

Elbadawi, Ayman; Barssoum, Kirolos; Abu‐Zaid, Ahmed; Rezq, Ahmed; Biniwale, Nishit; Alotaki, Erfan; Mohamed, Ahmed H.; Vuyyala, Sowjanya; Ogunbayo, Gbolahan; Saad, Marwan

doi:10.1080/00015385.2018.1475027

Cited by 33 publications

(24 citation statements)

References 23 publications

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“…In our analysis, we have also found a significant improvement in the reduction in migraine attacks and migraine days per month associated with PFO closure. Elbadawi et al conducted a meta-analysis of the 3 RCTs and concluded that PFO closure might be beneficial in migraine patients by reducing migraine attacks and migraine days, especially in patients whose majority of migraine attacks were with aura [27]. Our analysis reached a consensus with their conclusion.…”

Section: Discussionmentioning

confidence: 57%

“…Schwerzmann et al found that headache attacks in patients with migraine were reduced by >50%, whereas no reduction was observed in patients with nonmigraine headaches, which render a sole placebo effect unlikely [21]. By the same token, Elbadawi et al conducted a sensitivity analysis including only sham-controlled studies in the 3 RCTs' meta-analysis, and results also showed improvement of primary outcome with PFO closure [27], which support that the effect is unlikely to be caused just by a placebo effect. Similarly, it should not be ignored that the control group may also have placebo effects on patients due to sham procedure.…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy of Percutaneous Patent Foramen Ovale Closure on Migraine: a Meta-Analysis of Randomized Controlled Trials and Observational Studies

Zhang

Yan

et al. 2021

BioMed Research International

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Objectives. Whether patent foramen ovale (PFO) closure is effective on migraine is controversial. This article was aimed at assessing the efficacy of PFO closure on migraine based on randomized controlled trials (RCTs) and observational studies. Methods. We searched PubMed, Embase, and Cochrane databases up to October 2020 evaluating PFO closure versus control in patients with migraine, then conducted a meta-analysis of all RCTs and observational studies, respectively. The main outcomes were (1) respond rate: complete cessation of migraine; (2) reduction in the frequency of migraine attacks per month; and (3) reduction in migraine days per month. Results. Seven studies (3 RCTs and 4 observational studies), containing 887 migraine patients, were identified. (1) The respond rate of PFO closure on migraine was significantly higher than control group both in RCT subgroup and observational studies subgroup (OR 3.86, 95% CI 1.35-11.04, P = 0.01 in RCTs; OR 8.28, 95% CI 2.31-29.67, P = 0.001 in observational studies). (2) Reduction in frequency of migraine attacks was higher in PFO closure group compared with control group in the RCT subgroup analysis ( mean difference MD = 0.57 , 95% CI 0.23-0.90, P = 0.0009 ). (3) Reduction in migraine days was also higher in PFO closure group compared with control group in the RCT subgroup analysis ( MD = 1.33 , 95% CI 0.35-2.31, P = 0.008 ). Conclusions. PFO closure might be suitable for migraine patients, especially for migraine with aura, by cessation of migraine headaches or reducing migraine attacks and migraine days.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

The Efficacy of Percutaneous Patent Foramen Ovale Closure on Migraine: a Meta-Analysis of Randomized Controlled Trials and Observational Studies

Zhang

Yan

et al. 2021

BioMed Research International

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“…The PREMIUM trial did not achieve a> 50% reduction in number of monthly migraine attacks, but the subgroup with frequent aura demonstrated both improved responder rate and cessation rate. A meta‐analysis of the 3 trials found a decrease in mean monthly migraine attacks and migraine days, suggesting possible benefit of percutaneous closure 185 . A 2020 retrospective, single‐center study of 474 patients who underwent transcatheter PFO closure for cryptogenic stroke had a considerably longer follow‐up (median 3.2 years) than any of the 3 RCTs 159 .…”

Section: Mechanistic Implications Of Clinical Trialsmentioning

confidence: 99%

Migraine and Ischemic Stroke in Women. A Narrative Review

Tietjen

Maly

2020

Headache

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Objective/Background.-Migraine is associated with ischemic stroke. Women are 3-fold as likely as men to have migraine, and high estrogen states increase the risk of migraine with aura (MWA), venous thromboembolism (VTE), and of stroke. We review the epidemiological and mechanistic evidence of the migraine-stroke relationship and its risk factors, with a focus on women and conditions that exclusively or predominantly affect them.Methods.-We performed a search of MEDLINE/PubMed database, then a narrative review of the epidemiological evidence of the migraine-stroke relationship as well as the evidence for arterial, thrombophilic, and cardiac mechanisms to explain this connection. We examine the implications of this evidence for the diagnostic evaluation and treatment of MWA.Results.-MWA is associated with multiple stroke risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, atrial fibrillation, and patent foramen ovale. In women, MWA is also associated with biomarkers of endothelial activation, hormonal contraceptive use, pregnancy, and VTE. This suggests that a subset of auras may be secondary, that is, induced by ischemia related to microemboli or in situ thrombosis. MWA-associated ischemic stroke is more common in young (<45 years old) women with high frequency of migraine attacks, hormonal contraception use, and with pregnancy and preeclampsia. There is increasing evidence that cardioembolism, often in conjunction with thrombophilia, plays a prominent role in MWA-associated cerebral infarction.Conclusion.-The commonality of factors associated with MWA and with MWA-associated stroke suggest that persons with secondary, ischemia-induced aura may be at elevated risk of stroke. Although further research is needed, we recommend consideration of a diagnostic evaluation of MWA that mirrors the evaluation of transient ischemic attack, given that prophylactic treatment targeting the ischemic origin of secondary aura may prevent migraine as well as stroke.

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“…71 A meta-analysis of trials examining the effects of PFO closure in migraineurs concluded that the procedure may be beneficial in patients whose predominant migraine type includes aura. 72 However, a subsequent randomized controlled trial of 230 patients failed to reach the primary end point of a 50% reduction of migraine attacks after PFO closure. 73…”

Section: Managing the Comorbidities Of Migraine With Auramentioning

confidence: 99%

Migraine Aura: Pathophysiology, Mimics, and Treatment Options

et al. 2019

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Recent insights into the clinical presentation and pathophysiology of migraine aura have paved the way for new treatments for this common but frequently debilitating condition. Marked efflux of cellular potassium and glutamate contributes to the cortical spreading depression that forms the electrophysiological basis of migraine aura phenomena. Secondary vascular perturbations also contribute to the various symptoms of a migraine attack. Calcitonin gene-related peptide (CGRP) plays a key role in many of these steps, and a growing class of CGRP-antagonists have emerged as a novel, efficacious preventative therapy. It is still not fully understood why a preponderance of migraine aura symptoms is visual, and this issue is an active area of research. In addition, the pathophysiological changes responsible for visual snow syndrome are under investigation. Before diagnosing a patient with migraine aura, it is important to consider the differential diagnosis of transient visual phenomena, with attention to clinical features that may suggest conditions such as retinal disorders, transient ischemic attack, or occipital epilepsy.

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Meta-analysis of randomized trials on percutaneous patent foramen ovale closure for prevention of migraine

Cited by 33 publications

References 23 publications

The Efficacy of Percutaneous Patent Foramen Ovale Closure on Migraine: a Meta-Analysis of Randomized Controlled Trials and Observational Studies

The Efficacy of Percutaneous Patent Foramen Ovale Closure on Migraine: a Meta-Analysis of Randomized Controlled Trials and Observational Studies

Migraine and Ischemic Stroke in Women. A Narrative Review

Migraine Aura: Pathophysiology, Mimics, and Treatment Options

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