Preliminary study on the application of percutaneous patent foramen ovale (PFO) closure in the treatment of children with PFO and severe migraine

Abstract

Background: Numerous studies have shown that patent foramen ovale (PFO) is closely associated with migraine and PFO closure can significantly relieve migraine in adults. However, there are limited data on children. Therefore, this study aims to investigate the role of percutaneous PFO closure in children with PFO and severe migraine, thereby providing theoretical evidence for performing this procedure in the pediatric population.

Methods: In this study, we conducted a retrospective analysis of the clinical data from 46 children with PFO and severe migraine admitted to our hospital between September 2021 and October 2023 and assessed the relief of migraine after percutaneous PFO closure.

Results: All 46 children with PFO had severe migraine preoperatively. The PFO was determined by transthoracic echocardiography (TTE) and right heart contrast echocardiography suggested the presence of a significant right-to-left shunt (RLS). No residual shunt and complications were observed in all the children after intervention. Before PFO closure, every child experienced repeated migraines. Follow-up data for all patients were obtained by telephone, WeChat, or outpatient visits at 1, 6, 12, and 24 months after PFO closure. The migraine was significantly alleviated in 43 children, while three others experienced no change. There was a significant reduction in the frequency, duration, Visual Analogue Scale (VAS) score and Headache Impact Test-6 (HIT-6) score after PFO closure.

Conclusions: Percutaneous PFO closure may be considered for children with PFO and severe migraine who have not responded to other treatments, after excluding other headache causes. In some children, this procedure may significantly improve headache symptoms.

Keywords: Patent foramen ovale (PFO); children; percutaneous PFO closure; right heart contrast echocardiography; severe migraine.

Figure 1

Comparison of headache frequency, VAS score, HIT-6 score and duration before and after PFO closure at different follow-up time points. (*, P<0.05 vs. 0 M; ^, P<0.05 vs. 1 M; +, P<0.05 vs. 6 M). HIT-6, Headache Impact Test-6; M, month; VAS, Visual Analogue Scale.

Figure 2

Migraine effective rate over time. M, month; PFO, patent foramen ovale.

Figure 3

A 12-year-old girl with severe migraine and PFO. (A) Preoperative grade III RLS, with the left heart chamber filled with microbubbles. (B) One-month postoperative grade 0 RLS. PFO, patent foramen ovale; RSL, right-to-left shunt.