Resolution of Migraine with Aura Post-PFO Closure in a Young Female: A Case Report

BACKGROUND Migraine, a prevalent primary headache disorder, often disrupts daily life, particularly when accompanied by visual auras. While the etiology of migraines remains elusive, emerging evidence suggests a correlation with cardiovascular anomalies. CASE REPORT This case involves a 35-year-old woman experiencing migraine with aura. Imaging studies, including MRI/A, revealed small-vessel ischemic damage in the right frontal region and historical microbleeds in the right occipital area. The patient's RoPE score was a high 9 out of 10, and a grade 4 (severe) PFO was diagnosed following a TEE+bubble test. A transfemoral PFO closure was successfully performed using a 25-mm Amplatzer PFO occluder device via an antegrade transvenous approach without fluoroscopy. The patient was discharged in stable condition, with no migraine episodes reported at 5-month follow-up. The detection of PFO in young migraineurs, particularly those with aura, is crucial and warrants thorough investigation during their assessment and treatment. CONCLUSIONS This case underscores the importance of incorporating cardiac evaluations in the diagnostic regimen for young individuals presenting with migraine and aura to uncover and rectify potential contributory structural heart defects like PFO. After PFO closure, this patient's significant improvement, evidenced by the absence of migraine recurrence, highlights the potential therapeutic benefit of addressing cardiac anomalies in such patients. It is important to note that current evidence does not support PFO closure as a treatment for migraines unless there are findings suggestive of ischemic stroke.