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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
10:52

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

Published on: December 23, 2022

Migraine and patent foramen ovale: connecting flight or one-way ticket?

Gianluca Rigatelli1

  • 1Adult Congenital Heart Disease, Cardiovascular Diagnosis & Endoluminal Interventions, Roligo General Hospital, Roligo, Italy. jackyheart@libero.it

Expert Review of Neurotherapeutics
|September 2, 2008
PubMed
Abstract

Insights

Migraine with aura and patent foramen ovale (PFO) are linked, with larger PFOs increasing stroke risk. Transcatheter closure benefits many patients, suggesting a real connection beyond placebo.

Area of Science:

  • Neurology and Cardiology
  • Vascular Medicine
  • Medical Imaging

Background:

  • The relationship between patent foramen ovale (PFO) and migraine, particularly concerning paradoxical stroke, remains a subject of debate.
  • Some research suggests a higher-than-chance coincidence between migraine with aura and PFO, potentially indicating shared genetic factors.

Purpose of the Study:

  • To comprehensively review and clarify the connection between PFO and migraine.
  • To evaluate recent evidence regarding the PFO-migraine link and its implications for stroke risk.

Main Methods:

  • Conducted a Medline search (OVID, PubMed) for English literature from 1998-2008, including randomized trials, cohort studies, meta-analyses, reviews, and editorials.
  • Utilized keywords such as 'migraine,' 'patent foramen ovale,' 'prevalence,' 'echocardiography,' 'transcranial Doppler ultrasound,' 'magnetic resonance imaging,' 'coagulation abnormalities,' and 'transcatheter closure treatment.'
  • Supplemented search with conference proceedings and author's personal experience.

Main Results:

  • Echocardiographic, transcranial Doppler, and MRI studies indicate migraine patients have a higher stroke risk and often exhibit white matter brain lesions.
  • A significant proportion of PFO patients experience migraine, especially migraine with aura; those with both conditions show larger shunts.
  • Patients with migraine and large PFO face an increased risk of paradoxical embolism, with many showing positive responses to transcatheter closure.

Conclusions:

  • Despite existing uncertainties, migraine with aura and large PFO appear strongly associated in a subset of patients.
  • This association involves both anatomical and functional aspects, suggesting a significant link between these conditions.

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