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Updated: Sep 19, 2025

Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence

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Overlooked Trigger of Migraine: Clinical Significance of Small- and Medium-Shunt Patent Foramen Ovale

Jia-Ning Fan1, Ming-Fei Li1, Bei-Jian Zhang1

  • 1National Clinical Research Center for Interventional Medicine, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.

Cardiology
|June 5, 2025
PubMed
Abstract

Insights

Patent foramen ovale (PFO) closure improves migraine, especially with small-to-moderate shunts. This finding offers hope for migraine sufferers with PFO, highlighting shunt size as a key factor in treatment success.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Patent foramen ovale (PFO) is a common congenital heart defect linked to migraines.
  • The relationship between PFO size and migraine severity is not fully understood.

Purpose of the Study:

  • To investigate the impact of PFO size on migraine improvement after PFO closure.
  • To identify predictors of migraine relief following PFO closure.

Main Methods:

  • Retrospective analysis of 201 migraine patients who underwent PFO closure (Jan 2020-Dec 2022).
  • Patients classified into groups based on PFO shunt size: permanent shunt (PS) vs. non-PS, and large shunt under Valsalva maneuver (LSVM) vs. small-to-moderate shunt under Valsalva maneuver (SMSVM).
  • Migraine improvement and adverse events were recorded post-procedure.

Main Results:

  • PFO closure reduced migraine burden in both PS and LSVM groups.
  • The small-to-moderate shunt under Valsalva maneuver (SMSVM) group showed a lower rate of migraine alleviation (79.7% vs. 95.2%).
  • Small-to-moderate shunt under Valsalva maneuver (SMSVM) and medium-to-large residual shunt (MLRS) predicted migraine improvement; cryptogenic stroke history predicted migraine termination.

Conclusions:

  • Small-to-moderate shunt under Valsalva maneuver (SMSVM) PFO in migraine patients has positive intervention outcomes.
  • Both SMSVM and MLRS are associated with migraine relief.
  • A history of cryptogenic stroke is a predictor of migraine termination.
Keywords:
MigrainePatent foramen ovalePredictorsSmall and medium shunts

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