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Updated: Jul 14, 2026
10:52
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
The patent foramen ovale-migraine question
S J Tepper1, F D Sheftell, M E Bigal
1The New England Center for Headache, 778 Long Ridge Road, Stamford, CT 06902, USA. sjtepper@aol.com
Summary
Patent foramen ovale (PFO) closure may reduce migraine with aura days. While one study didn't meet its primary goal, it showed a significant reduction in migraine frequency, suggesting further research is needed.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Patent foramen ovale (PFO) is associated with migraine with aura.
- PFOs are also linked to conditions like cryptogenic strokes and hypoxemia.
- Pulmonary arteriovenous malformations in Osler-Weber-Rendu disease may also contribute to migraine with aura.
Purpose of the Study:
- To evaluate the efficacy of PFO closure in patients with migraine with aura.
- To investigate the relationship between PFO shunt severity and migraine with aura.
Main Methods:
- Review of open-label, retrospective, and case-controlled studies on PFO closure for migraine with aura.
- Analysis of the MIST trial, a prospective, sham-controlled study on PFO closure for migraine with aura.
Main Results:
- Multiple observational studies suggest PFO closure improves migraine with aura.
- The MIST trial did not meet its primary endpoint for migraine resolution but showed a significant association between PFO shunt severity and migraine with aura.
- A secondary endpoint in the MIST trial indicated a 42% reduction in migraine days.
Conclusions:
- While definitive evidence is pending, PFO closure shows promise for reducing migraine with aura frequency.
- Further randomized, sham-controlled trials are warranted to confirm the benefits of PFO closure for migraine with aura.
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