[Patent foramen ovale and migraine: where is the connection]

Patent foramen ovale (PFO) is an anatomic remnant of the fetal circulation that is highly prevalent in the general population. Several observational studies show that migraine with aura and PFO have higher coincidences than expected by chance. Both conditions might be linked by certain pathophysiological mechanisms, such as right-to-left shunting of venous agents or paradoxical embolism. Alternatively, they might share a common genetic background. No relevant differences have been found between the clinical features of migraine with FOP and those of migraine without FOP. The results of several observational studies suggest that PFO closure may have a beneficial effect on migraine. However, the first randomized, double-blind, and sham-controlled trial has failed to support such conclusion. Until there is more evidence from ongoing trials, PFO closure should not be performed in clinical practice for the treatment of migraine.