Patent foramen ovale in patients with migraine headache. Should it be closed?

Our objective is to review the epidemiology and proposed pathophysiology of migraine headache and its association with patent foramen ovale (PFO). We further elucidate the technical aspects of PFO closure and its possible impact on migraine headache. Upon reviewing English-language publications listed in MEDLINE relating to migraine headache, PFO; and transcatheter closure of PFO, we selected case series, retrospective and prospective studies relevant to the topic. PFO closure is being performed in annually increasing numbers worldwide for a variety of indications. The percutaneous technique of PFO closure has been shown to be safe and effective in multiple case series. Further, primarily retrospective case-control studies demonstrate a link between PFO closure and improvement of migraine headache. Few prospective data confirm the initial

However, the only randomized, controlled trial finished to date analyzing the effect of PFO closure on migraine failed to reach its primary outcome of resolution of migraine following the intervention. The evidence of a benefit on migraine headache following PFO closure is not convincing, but certainly intriguing. With currently ongoing trials, more information related to this topic can be expected. In the meantime, the question whether we should close PFOs in patients with migraine headaches cannot be answered.