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Updated: Feb 10, 2026
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Migraine as possible red flag of PFO presence in suspected demyelinating disease
E Signoriello1, M Cirillo2, G Puoti1
1Multiple Sclerosis Centre, II Division of Neurology, Department of Surgical Medical Science, Neurological, Metabolic and Aging, Interuniversity Center for research in Neurosciences, University of Campania L. Vanvitelli, Naples, Italy.
Objectives:
To investigate a possible association between isolated white matter lesions suggestive of demyelinating disease in magnetic resonance imaging (MRI) and patent foramen ovale (PFO) evidence in migraine patients, with or without aura.
Materials:
31 migraine patients, 28 females and 3 males, with MRI evidence of white matter lesions suggestive of demyelinating disease according to the Barkhof Criteria. All patients underwent further diagnostics including lumbar puncture, autoimmunity panel and cardiological evaluation to detect the presence of PFO. The mean duration of follow-up was 3.46 years and MIPAV software was used to analyze MRI imaging.
Results:
14 of the 31 patients (45%) had PFO. A significant association was found between PFO and migraine with visual aura (p < 0.001). No difference in lesion number, volume or area between patients with and without PFO was found, but the distribution was mainly occipital (p < 0.001) in patients with PFO. The follow-up showed a stationary lesion load in all PFO patients; no infratentorial or spinal cord lesion and no enhancement or corpus callosum lesion was ever detected. At the end of follow-up four patients developed multiple sclerosis: younger age at first MRI and oligoclonal bands were associated risk factors.
Conclusions:
Migraine is often one of the main symptoms leading to MRI, and in many cases white matter lesions of unspecific significance are discovered, thus placing demyelinating diseases in the differential diagnosis. Our study underlines the potential pathogenetic role of PFO in generating white matter lesions in migraine patients (45%), particularly those with visual aura and occipital lesions. For this reason, we affirm that PFO represents a cardinal point in the differential diagnosis of suspected demyelinating disease.
Insights
Patent foramen ovale (PFO) is associated with white matter lesions in migraine patients, especially those with visual aura. PFO may play a role in lesion development and should be considered in diagnosing demyelinating disease.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Migraine patients often present with white matter lesions on MRI, necessitating differential diagnosis with demyelinating diseases.
- Patent foramen ovale (PFO) is a potential, yet under-investigated, factor in neurological conditions.
- Understanding the link between PFO and white matter lesions in migraine is crucial for accurate diagnosis.
Purpose of the Study:
- To investigate the association between patent foramen ovale (PFO) and white matter lesions in migraine patients.
- To determine if PFO influences the characteristics and distribution of these lesions.
- To assess the role of PFO in the differential diagnosis of suspected demyelinating diseases in migraineurs.
Main Methods:
- Retrospective analysis of 31 migraine patients with MRI-detected white matter lesions suggestive of demyelinating disease.
- Diagnostic workup included lumbar puncture, autoimmunity panel, and cardiological evaluation for PFO detection.
- MRI scans were analyzed using MIPAV software over a mean follow-up of 3.46 years.
Main Results:
- Patent foramen ovale (PFO) was detected in 45% of the migraine patients.
- A significant association was found between PFO and migraine with visual aura (p < 0.001).
- Occipital lesion distribution was more common in patients with PFO; lesion load remained stable, with no infratentorial, spinal cord, or enhancing lesions observed.
Conclusions:
- Patent foramen ovale (PFO) may play a pathogenetic role in generating white matter lesions in migraine patients, particularly those with visual aura.
- The presence of PFO in migraine patients with white matter lesions warrants consideration in the differential diagnosis of demyelinating disease.
- Further research into the PFO-migraine-white matter lesion connection is essential for refining diagnostic and therapeutic strategies.
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