Clinical efficacy of percutaneous closure of patent foramen ovale in children diagnosed with migraine

Abstract

Objective: This retrospective analysis aimed to assess the clinical efficacy of patent foramen ovale (PFO) closure for the treatment of migraine in children.

Methods: Data from 35 children diagnosed with migraine and PFO (pre-intervention transthoracic echocardiography did not detect PFO in some, but saline contrast echocardiography was positive, indicating hidden PFO), admitted to Tianjin Children's Hospital for PFO closure between March 2020 and February 2024, were retrospectively collected and analysed. The efficacy of post-intervention pain relief was evaluated using an 11-point numerical rating scale (NRS-11), headache impact test-6 (HIT-6), and Paediatric Migraine Disability Assessment Score (PedMIDAS), migraine frequency, and duration of each migraine attack.

Results: At the 1-month follow-up after PFO closure, 20 patients (57.1%) achieved complete relief, and 29 (82.9%) had a reduction in migraine attack frequency by >50%. At the 12-month follow-up, 28 patients (80%) achieved complete relief, and 32 (91.4%) had a reduction in migraine attack frequency by >50%. There were no statistically significant differences between the aura and the non-aura groups. All patients exhibited statistically significant improvement (P < 0.05) in NRS-11, HIT-6, and PedMIDAS, migraine frequency, and duration of each migraine attack. The children in the aura group had a more significant decrease in NRS-11 than those in the non-aura group at 12-month after the operation (P < 0.05). Additionally, there were no statistically significant differences between the two groups in HIT-6, PedMIDAS, and duration of migraine attacks.

Conclusion: Percutaneous PFO closure demonstrated significant clinical efficacy and safety in the treatment of migraine in children.

Keywords: children; complete relief of headache; hidden PFO; migraine; percutaneous PFO closure; retrospective analysis.

Figure 1

Positive contrast-transcranial Doppler ultrasonography test with grade III.

Figure 2

Saline contrast echocardiography in the apical four-chamber view (A,B) reveals abundant contrast microbubbles in the left atrium and left ventricle, respectively, confirming a large right-to-left shunt.

Figure 3

Patent foramen ovale occlusion. (A) The guidewire enters the left upper pulmonary vein under digital subtraction angiography (DSA) guidance; (B) a multifunctional catheter is advanced into the left upper pulmonary vein under DSA guidance; (C) the stiff guidewire is introduced into the left upper pulmonary vein under DSA; (D) the delivery sheath is sent to the left atrium along the stiff guidewire; (E) the delivery sheath is transferred to the left chamber; (F) the occluder is deployed in the oval hole; (G) the occluder is released in the left front oblique position and the occluder is in the tangential position; (H) The position of the occluder is satisfactory.

Figure 4

Ultrasound changes before and after intervention. (A) Ultrasound before plugging; (B) Short axial section of the great artery after closure; (C) Four-chamber view of the heart apex after closure; (D) Double-compartment section below the xiphoid process after closure.

Figure 5

Changes in the remission rate of migraine with aura and migraine without aura over time. (A) Complete Remission Rate; (B) Remission Rate ≥50%. MA, Migraine with aura; MO, Migraine without aura; TOTAL, the overall patient group. M0, 3 months before the intervention; M1, 1 month after intervention; M12, 12 months after intervention.

Figure 6

Changes in headache-related scores in children with migraine with aura and in those with migraine without aura after patent foramen ovale closure.