Ticagrelor for refractory migraine/patent foramen ovale (TRACTOR): An open-label pilot study

Adam M. Reisman, Barbara T. Robbins, Denise E. Chou, Marianna Shnayderman Yugrakh, Giti J. Gross, Lauren Privitera, Tamim Nazif, Robert J. Sommer

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objective After finding that the thienopyridines clopidogrel and prasugrel reduced migraine headache (MHA) symptoms in some patients with patent foramen ovale (PFO), this small pilot study was undertaken to determine whether ticagrelor, a nonthienopyridine P2Y12 inhibitor, would have similar MHA effects and might be better suited for a future randomized trial. Methods MHA patients were screened for PFO. Participants with documented right to left shunt (RLS) and .6 monthly MHA days received ticagrelor therapy for 28 days. Those with .50% reduction in monthly MHA days were deemed responders and completed 2 additional treatment months. Results The 40 participants had a mean age of 36.2 years and mean MHA frequency of 17.4 d/mo. A total of 39/40 were female. A total of 14/40 met criteria for episodic MHA, 26/40 for chronic MHA, 14/40 had migraine with aura, and 22/40 had a moderate.large RLS (Spencer grade .4). Seventeen of 40 participants (43%) were responders.MHAreduction continued through 3 treatment months in all responders. MHA responder rates were not statistically different in participants with episodic or chronic MHA, with or without aura, or with small/larger RLS shunt magnitude. Thirteen (32%) patients had medication side effects, without serious adverse events. Conclusion P2Y12 inhibition with ticagrelor reduced MHA symptoms similarly to our previous thienopyridine experience, but participants seemed to have a less robust MHA benefit and more frequent side effects than with the thienopyridines, making it an inferior choice for a randomized trial. Classification of evidence This study provides Class IV evidence that ticagrelor reduced MHA symptoms in patients with PFO.

Original languageEnglish
Pages (from-to)1010-1017
Number of pages8
Issue number22
StatePublished - 2018
Externally publishedYes


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