Transcatheter closure of patent foramen ovale in children with migraine or dizziness.

UNLABELLED: In recent years, several studies have suggested that transcatheter patent foramen ovale (PFO) closure can relieve migraine and may also improve unexplained dizziness in adults, but evidence in children remains limited. We retrospectively analyzed 95 children (45 boys; age 5.00-18.00 years) who underwent transcatheter PFO closure between June 2019 and September 2024 and were followed for a median of 18.00 months (interquartile range [IQR]: 9.00-27.00). Indications were severe migraine (n = 83; 33 also had dizziness) or recurrent dizziness without migraine (n = 12). Efficacy was evaluated by monthly migraine frequency, Headache Impact Test-6 (HIT-6), Numeric Rating Scale (NRS), and Dizziness Handicap Inventory-Short Form (DHI-S). Safety was assessed by procedural success, fluoroscopy time, dose-area product (DAP), and complications. Closure was successful in 95.96% of cases. Median fluoroscopy time and DAP were 456.00 s (IQR: 341.00-600.00) and 10.73 Gy·cm2 (IQR: 7.16-18.97), respectively. Two transient atrial arrhythmias and one femoral arteriovenous fistula occurred. Among the 83 migraine patients, 23 achieved complete remission and 52 showed partial improvement (overall response 90.36%); monthly migraine frequency, HIT-6 and NRS scores all fell significantly (P < 0.01). DHI-S scores improved both in children with migraine-associated dizziness and in those with isolated dizziness.

CONCLUSION

Transcatheter PFO closure appears safe in children and can alleviate migraine and/or dizziness in the majority of cases in our cohort.

WHAT IS KNOWN: • Patent foramen ovale is associated with both migraine and unexplained dizziness. PFO closure has been reported to alleviate migraine in selective adult patients and may improve unexplained dizziness of some adults. • There is limited research on PFO closure in children, and the effectiveness and safety of PFO closure in children remain unclear.

WHAT IS NEW: • Transcatheter PFO closure can also alleviate migraine and dizziness associated with PFO in majority of pediatric patients. • Transcatheter PFO closure appears safe and reliable in children.