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Updated: Jun 5, 2026

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

May migraine post-patent foramen ovale closure sustain the microembolic genesis of cortical spread depression?

Gianluca Rigatelli1, Paolo Cardaioli, Fabio Dell'Avvocata

  • 1Adult Congenital and Structural Heart Disease, Cardiovascular Diagnosis and Interventions Unit, Rovigo General Hospital, Via Mozart, 9, 37045 Legnago, Verona, Italy. jackyheart@libero.it

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|January 4, 2011
PubMed
Abstract

Insights

Migraine attacks immediately after PFO closure may predict long-term migraine with aura resolution. This suggests microembolization plays a role in migraine genesis, potentially through cortical spreading depression.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Cortical spreading depression is implicated in migraine pathophysiology, but its triggers remain unclear.
  • The microembolic hypothesis suggests microembolization promotes cortical spreading depression.
  • This study investigates the link between microembolization and migraine in patients undergoing PFO closure.

Purpose of the Study:

  • To explore the relationship between early post-procedural migraine attacks and long-term migraine outcomes after transcatheter PFO closure.
  • To assess the role of microembolization in migraine genesis, specifically in the context of PFO closure.

Main Methods:

  • Retrospective analysis of 42 migraine patients with prior stroke who underwent transcatheter PFO closure.
  • Recording and analysis of procedural, technical, and clinical variables.
  • Investigating correlations between post-procedural migraine, migraine improvement, and microembolization indicators.

Main Results:

  • 38% of patients experienced immediate post-procedural migraine attacks (mean duration 3.5 hours).
  • Patients with immediate attacks often had severe migraine with aura and persistent shunts.
  • Long-term follow-up (mean 32.2 months) showed aura resolution and symptom improvement exclusively in patients with post-procedural migraine.

Conclusions:

  • Findings indirectly support the in vivo microembolization-driven cortical spreading depression hypothesis in humans.
  • Results align with recent theories linking air microbubbles, cerebral deoxygenation, and cortical spreading depression.
  • Early post-PFO closure migraine attacks may serve as a marker for long-term migraine improvement, supporting the microembolic hypothesis.

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