Coincidental impact of transcatheter patent foramen ovale closure on migraine with and without aura - A comprehensive meta-analysis

Siddak M. Kanwar, Amit Noheria, Christopher V. Desimone, Alejandro Rabinstein, Samuel J Asirvatham

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background We analyzed the literature to assess the coincidental impact on migraines of transcatheter patent foramen ovale (PFO) closure performed for secondary stroke prevention. Methods We searched Medline, EMBASE, and the Cochrane database for studies published up until August 2013. We included English-language studies that provided information on complete resolution or improvement in migraine headaches following PFO closure. Two study authors identified 375 original articles and both independently reviewed 32 relevant manuscripts. Data including study methodology, inclusion criteria, PFO closure and migraine outcomes were extracted manually from all eligible studies. Pooled odds (and probability) of resolution or improvement of migraine headaches were calculated using random-effects models. Results Twenty studies were analyzed. Most were uncontrolled studies that included a small number of patients with cryptogenic stroke who had undergone PFO closure and had variable time of follow-up. The probability of complete resolution of migraine with PFO closure (18 studies, 917 patients) was 0.46 (95% confidence interval 0.39, 0.53) and of any improvement in migraine (17 studies, 881 patients) was 0.78 (0.74, 0.82). There was evidence for publication bias in studies reporting on improvement in migraines (Begg's p = 0.002), but not for studies on complete resolution of migraine (p = 0.3). In patients with aura, the probability of complete resolution of migraine post-PFO closure was 0.54 (0.43, 0.65), and in those without aura, complete resolution occurred in 0.39 (0.29, 0.51). Conclusions Among patients with unexplained stroke and migraine undergoing transcatheter PFO closure, resolution of headaches occurred in a majority of patients with aura and for a smaller proportion of patients without aura.

Original languageEnglish (US)
Pages (from-to)7-13
Number of pages7
JournalClinical Trials and Regulatory Science in Cardiology
Volume15
DOIs
StatePublished - Mar 1 2016

Fingerprint

Migraine without Aura
Migraine with Aura
Patent Foramen Ovale
Migraine Disorders
Meta-Analysis
Epilepsy
Stroke
Publication Bias
Manuscripts
Secondary Prevention
Headache
Language
Databases
Confidence Intervals

Keywords

  • Migraine
  • Patent foramen ovale
  • Transcatheter closure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Coincidental impact of transcatheter patent foramen ovale closure on migraine with and without aura - A comprehensive meta-analysis",
abstract = "Background We analyzed the literature to assess the coincidental impact on migraines of transcatheter patent foramen ovale (PFO) closure performed for secondary stroke prevention. Methods We searched Medline, EMBASE, and the Cochrane database for studies published up until August 2013. We included English-language studies that provided information on complete resolution or improvement in migraine headaches following PFO closure. Two study authors identified 375 original articles and both independently reviewed 32 relevant manuscripts. Data including study methodology, inclusion criteria, PFO closure and migraine outcomes were extracted manually from all eligible studies. Pooled odds (and probability) of resolution or improvement of migraine headaches were calculated using random-effects models. Results Twenty studies were analyzed. Most were uncontrolled studies that included a small number of patients with cryptogenic stroke who had undergone PFO closure and had variable time of follow-up. The probability of complete resolution of migraine with PFO closure (18 studies, 917 patients) was 0.46 (95{\%} confidence interval 0.39, 0.53) and of any improvement in migraine (17 studies, 881 patients) was 0.78 (0.74, 0.82). There was evidence for publication bias in studies reporting on improvement in migraines (Begg's p = 0.002), but not for studies on complete resolution of migraine (p = 0.3). In patients with aura, the probability of complete resolution of migraine post-PFO closure was 0.54 (0.43, 0.65), and in those without aura, complete resolution occurred in 0.39 (0.29, 0.51). Conclusions Among patients with unexplained stroke and migraine undergoing transcatheter PFO closure, resolution of headaches occurred in a majority of patients with aura and for a smaller proportion of patients without aura.",
keywords = "Migraine, Patent foramen ovale, Transcatheter closure",
author = "Kanwar, {Siddak M.} and Amit Noheria and Desimone, {Christopher V.} and Alejandro Rabinstein and Asirvatham, {Samuel J}",
year = "2016",
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T1 - Coincidental impact of transcatheter patent foramen ovale closure on migraine with and without aura - A comprehensive meta-analysis

AU - Kanwar, Siddak M.

AU - Noheria, Amit

AU - Desimone, Christopher V.

AU - Rabinstein, Alejandro

AU - Asirvatham, Samuel J

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background We analyzed the literature to assess the coincidental impact on migraines of transcatheter patent foramen ovale (PFO) closure performed for secondary stroke prevention. Methods We searched Medline, EMBASE, and the Cochrane database for studies published up until August 2013. We included English-language studies that provided information on complete resolution or improvement in migraine headaches following PFO closure. Two study authors identified 375 original articles and both independently reviewed 32 relevant manuscripts. Data including study methodology, inclusion criteria, PFO closure and migraine outcomes were extracted manually from all eligible studies. Pooled odds (and probability) of resolution or improvement of migraine headaches were calculated using random-effects models. Results Twenty studies were analyzed. Most were uncontrolled studies that included a small number of patients with cryptogenic stroke who had undergone PFO closure and had variable time of follow-up. The probability of complete resolution of migraine with PFO closure (18 studies, 917 patients) was 0.46 (95% confidence interval 0.39, 0.53) and of any improvement in migraine (17 studies, 881 patients) was 0.78 (0.74, 0.82). There was evidence for publication bias in studies reporting on improvement in migraines (Begg's p = 0.002), but not for studies on complete resolution of migraine (p = 0.3). In patients with aura, the probability of complete resolution of migraine post-PFO closure was 0.54 (0.43, 0.65), and in those without aura, complete resolution occurred in 0.39 (0.29, 0.51). Conclusions Among patients with unexplained stroke and migraine undergoing transcatheter PFO closure, resolution of headaches occurred in a majority of patients with aura and for a smaller proportion of patients without aura.

AB - Background We analyzed the literature to assess the coincidental impact on migraines of transcatheter patent foramen ovale (PFO) closure performed for secondary stroke prevention. Methods We searched Medline, EMBASE, and the Cochrane database for studies published up until August 2013. We included English-language studies that provided information on complete resolution or improvement in migraine headaches following PFO closure. Two study authors identified 375 original articles and both independently reviewed 32 relevant manuscripts. Data including study methodology, inclusion criteria, PFO closure and migraine outcomes were extracted manually from all eligible studies. Pooled odds (and probability) of resolution or improvement of migraine headaches were calculated using random-effects models. Results Twenty studies were analyzed. Most were uncontrolled studies that included a small number of patients with cryptogenic stroke who had undergone PFO closure and had variable time of follow-up. The probability of complete resolution of migraine with PFO closure (18 studies, 917 patients) was 0.46 (95% confidence interval 0.39, 0.53) and of any improvement in migraine (17 studies, 881 patients) was 0.78 (0.74, 0.82). There was evidence for publication bias in studies reporting on improvement in migraines (Begg's p = 0.002), but not for studies on complete resolution of migraine (p = 0.3). In patients with aura, the probability of complete resolution of migraine post-PFO closure was 0.54 (0.43, 0.65), and in those without aura, complete resolution occurred in 0.39 (0.29, 0.51). Conclusions Among patients with unexplained stroke and migraine undergoing transcatheter PFO closure, resolution of headaches occurred in a majority of patients with aura and for a smaller proportion of patients without aura.

KW - Migraine

KW - Patent foramen ovale

KW - Transcatheter closure

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DO - 10.1016/j.ctrsc.2016.01.002

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VL - 15

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EP - 13

JO - Clinical Trials and Regulatory Science in Cardiology

JF - Clinical Trials and Regulatory Science in Cardiology

SN - 2405-5875

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