Pediatr Cardiol. 2026 May 25. doi: 10.1007/s00246-026-04310-3. Online ahead of print.
ABSTRACT
To evaluate whether transcatheter patent foramen ovale (PFO) closure is associated with higher rates of complete migraine remission in children with migraine and a concomitant right-to-left shunt. We conducted a single-center retrospective cohort study of children with migraine and PFO-mediated right-to-left shunting. The primary exposure was transcatheter PFO closure; the primary outcome was complete migraine remission (no attacks for ≥ 3 consecutive months) assessed at 1, 3, 6, and 12 months post-discharge. Kaplan-Meier and multivariable Cox regression with a 3-month landmark were adjusted for right-to-left shunt (RLS) grade, age, sex, duration of the current headache episode, body mass index, and concomitant flunarizine prophylaxis. Among 66 children (mean age 10.3 years; 67% male), 19 underwent transcatheter PFO closure, and 47 received medical management. Complete migraine remission within 12 months occurred in 17/19 (89.5%) of closure patients versus 20/47 (42.6%) of non-closure patients (log-rank p = 0.002). In the adjusted Cox model, closure was associated with remission (hazard ratio [HR] 3.60, 95% confidence interval [CI] 1.38-9.42, p = 0.009); the association persisted after stratification for RLS (HR 3.18, 95% CI 1.26-8.04). A graded pattern was observed across three strata: no treatment 34.4%, flunarizine 60.0%, closure 89.5% (Kendall τ = 0.45, p < 0.001). All 19 procedures achieved complete closure without complications. Transcatheter PFO closure was associated with higher rates of complete migraine remission after adjustment for shunt grade, prophylaxis, and other covariates. Findings are hypothesis-generating; prospective randomized studies are needed before closure can be recommended for pediatric migraine outside clinical trials.
PMID:42184036 | DOI:10.1007/s00246-026-04310-3