Patent foramen ovale: paradoxical connection to migraine and stroke

In this article we aim to elucidate the relationship between patent foramen ovale, cryptogenic stroke and migraine.

Small observational and case-control studies indicate that patients with cryptogenic stroke have a higher incidence of patent foramen ovale. Prospective trials could not show a higher stroke recurrence risk with isolated patent foramen ovale. The combination of patent foramen ovale and atrial septal aneurysm might carry a higher recurrence risk. Secondary prevention with acetylsalicylic acid is as effective as oral anticoagulation, but carries a lower bleeding risk. Whether patent foramen ovale closure prevents recurrent strokes is under investigation. Case-control studies and retrospective analyses indicate comorbidity between patent foramen ovale and migraine, in particular migraine with aura. Recent retrospective studies indicate a reduction in migraine frequency after patent foramen ovale closure (intended for stroke prevention). These studies, however, have major methodological limitations. Therefore patent foramen ovale closure cannot be recommended for the prevention of migraine with aura.

At present routine percutaneous closure of isolated patent foramen ovale cannot be recommended for patients with cryptogenic stroke. Patent foramen ovale closure should not be used for the prevention of migraine.