Closing PFO closure for migraine

This editorial refers to ‘Percutaneous closure of patent foramen ovale in migraine with aura, a randomized controlled trial’, by H.P. Mattle et al . on doi:10.1093/eurheartj/ehw027 Mattle and co-workers present PRIMA, a randomized clinical trial comparing patent foramen ovale (PFO) closure using the Amplatzer occluder with medical management in patients suffering from migraine with aura (MA).1 The primary endpoint—the reduction in monthly migraine days between months 9 and 12 after randomization and 3 months before randomization—was not reached. Numerically, patients after PFO closure had a 1.2 day greater reduction in migraine days per month than controls, but this difference was not statistically significant. A secondary endpoint—response to therapy as defined by a reduction ≥50% of migraine days per month—was significant (38% of PFO closure patients vs. 15% of controls). Serious adverse events (SAE) occurred in 13% of closure patients and were procedure related in 11%; no SAE had lasting consequences. The PRIMA trial was terminated early due to slow enrolment. Of …