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Updated: Sep 30, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Cryptogenic Ischemic Stroke in Migraine: Role of Patent Foramen Ovale
Cédric Gollion1,2, Fleur Lerebours1, Marianne Barbieux-Guillot1
1Department of Neurology, University Hospital of Toulouse, Toulouse, France.
Introduction:
Migraine with aura (MWA) has been associated with cryptogenic ischemic stroke (CIS) after adjustment for the presence of a patent foramen ovale (PFO) assessed by a transcranial Doppler. This study aimed at evaluating the association of MWA with causal PFO assessed by Transesophageal echocardiography (TEE) in CIS.
Methods:
Patients aged 18-54 years consecutively treated for first acute ischemic stroke in a university hospital stroke unit, between January 2017 and December 2019, were included in this cross-sectional study. Associations between migraine subtypes and PFO were tested for all PFO, possibly causal PFO (PFO with large shunt and/or atrial septal aneurysm [ASA]), and the probably causal PFO subset (large shunt and/or ASA, plus risk of paradoxical embolism [RoPE] score ≥ 7). We adjusted the association between migraine subtypes and possibly causal PFO, which included the probably causal subset for age, sex, large artery atherosclerosis, and small vessel disease.
Results:
A total of two hundred and two patients with CIS were included, of whom 42/202 (20%) had MWA, 32/202 (15%) had migraine without aura, and 128/202 (63%) had no migraine. MWA was associated with possibly causal PFO (OR = 4.0, 95%CI [1.78-9.3], P < 0.001) and with probably causal PFO (OR = 5.4, 95%CI [2.37-13], P < 0.001). In a multinomial logistic regression analysis, MWA remained associated with possibly causal PFO (OR = 3.24, 95% CI [1.45-7.2], P = 0.004).
Conclusion:
In a young adult population with CIS, MWA was strongly associated with possibly causal PFO, i.e., with a large shunt or combined with an interatrial septal aneurysm.
Insights
Migraine with aura (MWA) is linked to a higher risk of cryptogenic ischemic stroke (CIS) due to a possibly causal patent foramen ovale (PFO). This association was confirmed using Transesophageal echocardiography (TEE) in young adults.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Migraine with aura (MWA) has been anecdotally linked to cryptogenic ischemic stroke (CIS).
- The role of patent foramen ovale (PFO) in this association, particularly when assessed by Transesophageal echocardiography (TEE), requires further investigation.
Purpose of the Study:
- To evaluate the association between MWA and PFO, specifically causal PFO, in patients diagnosed with CIS.
- To determine if MWA is independently associated with PFO in the context of CIS.
Main Methods:
- A cross-sectional study included 202 patients aged 18-54 with first acute ischemic stroke.
- Patients were assessed for MWA and PFO using TEE.
- Statistical analyses, including logistic regression, were performed to determine associations, adjusting for stroke risk factors.
Main Results:
- 20% of CIS patients had MWA.
- MWA was significantly associated with possibly causal PFO (OR=4.0) and probably causal PFO (OR=5.4).
- MWA remained independently associated with possibly causal PFO after adjusting for confounders (OR=3.24).
Conclusions:
- In young adults with CIS, MWA is strongly associated with possibly causal PFO.
- This suggests PFO, particularly with large shunts or atrial septal aneurysms, may play a role in MWA-related strokes.
