Clinical Report: Migraine therapy in congenital heart disease
Overview
The COMPETE trial evaluated the efficacy of aspirin, clopidogrel, and rivaroxaban compared to metoprolol in preventing migraines in patients with patent foramen ovale. All three antithrombotic agents demonstrated noninferiority to metoprolol.
Background
Migraine management in patients with congenital heart disease, particularly those with patent foramen ovale, presents unique challenges. The COMPETE trial provides insights into the role of antithrombotic agents in migraine prevention.
Data Highlights
| Medication | Responder Rate |
|---|---|
| Aspirin | 62% |
| Clopidogrel | 67% |
| Rivaroxaban | 78% |
| Metoprolol | 62% |
Key Findings
- Rivaroxaban had a responder rate of 78%, significantly higher than metoprolol's 62%.
- All antithrombotic agents met noninferiority criteria compared to metoprolol.
- Complete migraine cessation was more common in patients receiving rivaroxaban.
- Rivaroxaban was associated with greater reductions in migraine days and attacks compared to metoprolol.
- No major bleeding events were reported during the trial.
Clinical Implications
The findings indicate that antithrombotic agents may be considered for migraine prevention in patients with patent foramen ovale.
Conclusion
The COMPETE trial provides data on antithrombotic therapies in migraine management for patients with congenital heart disease.
Related Resources & Content
- Li Z, et al., The BMJ, 2026 -- Antithrombotic treatment for migraine in patients with patent foramen ovale: multicentre, randomised, active controlled, open label trial
- Phoenix Children's Medical Connection, 2026 -- Migraine: Acute, Preventive and Interventional Strategies
- MDSpire News, 2026 -- IHS, ACP Differ on Migraine Tx
- MDSpire News, 2026 -- Trio of Trials Track Early Migraine Drug Response
- Neurology, 2026 -- Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations
- Frontiers in Neurology — A victim of its own progress: why the success of modern therapeutics forces a re-evaluation of placebo-controlled trials in migraine prevention
- Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults
- Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations | Neurology
- Antithrombotic treatment for migraine in patients with patent foramen ovale: multicentre, randomised, active controlled, open label trial - PubMed
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