Related Experiment Video
Updated: Jan 15, 2026
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Migraine and patent foramen ovale: correlation, coexistence, dependence. A narrative review
Olga Grodzka1,2, Michał Borończyk3,4, Anna Zduńska1
1Department of Neurology, Faculty of Medicine and Dentistry, Bielanski Hospital, Medical University of Warsaw, Warsaw, Poland.
Objective:
This review was conducted to analyze the current knowledge on the topic of the relation between migraine and patent foramen ovale (PFO) and indicate the most crucial clinical implications.
Background:
Migraine is a primary headache disorder that affects a significant part of the global population. Importantly, it has been considered a risk factor for ischemic stroke, especially in women with migraine with aura. The foramen ovale is a physiological opening in the atrial septum formed during fetal life, which closes in most people in the first year after birth. However, in some people, it can be present in adulthood and is called the patent foramen ovale. PFO is more likely to occur in patients with migraine compared to the population not experiencing migraine headaches.
Methods:
Two review teams, comprising migraine experts and stroke experts, were engaged in the screening process, resulting in the inclusion of 204 relevant publications. To be considered for inclusion, an article had to directly cover the topic of PFO or migraine.
Results:
In the following work, we have focused on several aspects regarding the direct and indirect relationship between migraine and PFO. Although analyzing migraine pathogenesis, apart from the straight link between PFO and migraine, others are also considered, such as a prominent Eustachian valve or Chiari valve, causing a high-risk PFO or a paradoxical embolism. Regarding the clinical practice, the prevalence of PFO and migraine, indications for exact therapies, and subsequently, neuroimaging in the view of PFO and migraine, have been scrutinized. Another crucial aspect of this review is the risk of stroke in patients with migraine, considering the PFO presence. It is suggested that patients with migraine have more vascular lesions on magnetic resonance imaging and more often experience strokes. Thus, the question arises whether PFO should be closed as stroke prophylaxis in every migraine patient.
Conclusions:
Several aspects have been explored; however, more research is needed to draw clear conclusions with further indications for clinical practice. Nevertheless, it seems that not in all patients with migraine with PFO should the closure procedure be performed, but when the PFO is of a high-risk form or there are other indications, it should at least be considered.
Insights
Patent foramen ovale (PFO) is more common in migraine patients and may increase stroke risk. PFO closure may be considered for high-risk migraine patients, but more research is needed for definitive clinical guidance.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Migraine is a prevalent primary headache disorder associated with an increased risk of ischemic stroke, particularly in women with aura.
- A patent foramen ovale (PFO) is a persistent opening between the heart's atria, more frequently found in migraine sufferers than the general population.
- The relationship between migraine and PFO suggests potential pathophysiological links and clinical implications for stroke prevention.
Purpose of the Study:
- To review current knowledge on the relationship between migraine and PFO.
- To analyze the clinical implications of this association, including stroke risk and treatment strategies.
- To explore the role of PFO in migraine pathogenesis and its impact on neuroimaging findings.
Main Methods:
- A comprehensive literature review was conducted, including 204 relevant publications.
- Two expert teams, specializing in migraine and stroke, screened the literature.
- Inclusion criteria required articles to directly address either PFO or migraine.
Main Results:
- The review examined the direct and indirect links between PFO and migraine, considering factors like Eustachian valve and Chiari valve abnormalities contributing to high-risk PFO and paradoxical embolism.
- Clinical aspects, including the prevalence of PFO and migraine, therapeutic indications, and neuroimaging findings, were scrutinized.
- Evidence suggests migraine patients with PFO may have more vascular lesions and a higher stroke incidence, raising questions about PFO closure for stroke prophylaxis.
Conclusions:
- While the association between migraine and PFO is evident, further research is necessary to establish clear clinical guidelines.
- PFO closure should not be universally recommended for all migraine patients with PFO.
- Consideration for PFO closure should be given in cases of high-risk PFO or other specific indications for stroke prevention.
Related Concept Videos
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:20Mitral Regurgitation I: Introduction
01:22Mitral Stenosis I: Introduction
01:19Mitral Valve Prolapse III: Nursing Management
01:25Glaucoma: Overview
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests