Dataset Information

Association of migraine with patent foramen ovale closure: A systematic review and meta-analysis.

ABSTRACT:

Background

The potential correlation between patent foramen ovale (PFO) and migraine has been previously reported, but whether PFO closure plays a role in reducing migraine burden has not reached an agreement.

Method

We searched PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Science Technology Periodical Database and China Biology Medicine Database (CBM) through September 30, 2021 to identify associations between PFO closure and outcome of migraine burden. The control groups consisted of drug treatment or sham procedure.

Result

Three randomized clinical trials (RCT) and 9 case-control studies were eligible for inclusion (1754 participants), of which 7 reported nonrecurrence of migraine, 4 reported reduced migraine-frequency and migraine-days, and 5 reported HIT-6 score and 4 reported MIDAS score. The mean (SD) age of participants was 40.68 (3.81) years and 1340 (76.39%) were women. PFO closure was significantly associated with a reduced risk of migraine-recurrence by 4.47 (95% CI, 2.94-6.80; I² = 12%), frequency of migraine by 0.35 (95% CI, 0.17-0.53; I² = 0%) and monthly migraine days by 0.28 (95% CI, 0.10-0.46), and decreased score of HIT-6 (SMD 1.23, 95 %CI 0.52-1.95, I² = 93%).

Conclusion

Transcatheter PFO closure is significantly associated with burden reduction of migraine headache.

SUBMITTER: Wang YL

PROVIDER: S-EPMC8938194 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Association of migraine with patent foramen ovale closure: A systematic review and <i>meta</i>-analysis.

Wang Yan-Li YL Wang Fang-Ze FZ Zhang Yuan Y Jiang Jiwei J Jia Ziyan Z Liu Xiangrong X Wang Jian J Xu Jun J

International journal of cardiology. Heart & vasculature 20220318

<h4>Background</h4>The potential correlation between patent foramen ovale (PFO) and migraine has been previously reported, but whether PFO closure plays a role in reducing migraine burden has not reached an agreement.<h4>Method</h4>We searched PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Science Technology Periodical Database and China Biology Medicine Database (CBM) through September 30, 2021 to identify associations between PFO closure and outcome of mi ...[more]

PMID: 35330668

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Project description:ObjectiveTo examine the relative impact of three management options in patients aged <60 years with cryptogenic stroke and a patent foramen ovale (PFO): PFO closure plus antiplatelet therapy, antiplatelet therapy alone and anticoagulation alone.DesignSystematic review and network meta-analysis (NMA) supported by complementary external evidence.Data sourcesMedline, EMBASE and Cochrane CENTRAL.Study selectionRandomised controlled trials (RCTs) addressing PFO closure and/or medical therapies in patients with PFO and cryptogenic stroke.Review methodsWe conducted an NMA complemented with external evidence and rated certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.ResultsTen RCTs in eight studies proved eligible (n=4416). Seven RCTs (n=3913) addressed PFO closure versus medical therapy. Of these, three (n=1257) addressed PFO closure versus antiplatelet therapy, three (n=2303) addressed PFO closure versus mixed antiplatelet and anticoagulation therapies and one (n=353) addressed PFO closure versus anticoagulation. The remaining three RCTs (n=503) addressed anticoagulant versus antiplatelet therapy. PFO closure versus antiplatelet therapy probably results in substantial reduction in ischaemic stroke recurrence (risk difference per 1000 patients over 5 years (RD): -87, 95% credible interval (CrI) -100 to -33; moderate certainty). Compared with anticoagulation, PFO closure may confer little or no difference in ischaemic stroke recurrence (low certainty) but probably has a lower risk of major bleeding (RD -20, 95% CrI -27 to -2, moderate certainty). Relative to either medical therapy, PFO closure probably increases the risk of persistent atrial fibrillation (RD 18, 95% CI +5 to +56, moderate certainty) and device-related adverse events (RD +36, 95% CI +23 to +50, high certainty). Anticoagulation, compared with antiplatelet therapy, may reduce the risk of ischaemic stroke recurrence (RD -71, 95% CrI -100 to +17, low certainty), but probably increases the risk of major bleeding (RD +12, 95% CrI -5 to +65, moderate certainty).ConclusionsIn patients aged <60 years, PFO closure probably confers an important reduction in ischaemic stroke recurrence compared with antiplatelet therapy alone but may make no difference compared with anticoagulation. PFO closure incurs a risk of persistent atrial fibrillation and device-related adverse events. Compared with alternatives, anticoagulation probably increases major bleeding.Prospero registration numberCRD42017081567.