Skip to main content

Advertisement

Log in

Migraine and Patent Foramen Ovale

  • Headache (R Halker, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Migraine is a widespread disorder with a large impact on society. Patent foramen ovale (PFO) is a common occurrence, affecting about 25 % of the population. Observational studies report PFO to be more prevalent in patients with migraine with aura, and patients with migraine with aura have a higher incidence of PFO. The only population-based study does not support this link. It is possible that an association exists between large-sized PFO and migraine. This association may explain how migraine with aura can be triggered. Numerous studies have reported improved migraine with PFO closure, but the only prospective placebo-controlled trial aimed at closure of PFO in patients with migraine with aura did not support this. At this time, evidence does not support the routine detection and closure of PFO in patients with migraine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lipton RB, Stewart WF, Diamond S, et al. Prevalence and burden of migraine in the United States; Data from the American Migraine Study II. Headache. 2001;41:646–57.

    Article  CAS  PubMed  Google Scholar 

  2. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders 3rd Edition (beta version). Cephalalgia. 2013;33:645–66.

    Article  Google Scholar 

  3. Weber F, Goriup A. Prevalence of right to-left shunts in active fighter pilots. Aviat Space Environ Med. 2007;78:135–6.

    PubMed  Google Scholar 

  4. • Sharma A, Gheewala N, Silver P. Role of patent foramen ovale in migraine etiology and treatment: a review. Echocardiography. 2011;28:913–7. Good review of data.

    Article  PubMed  Google Scholar 

  5. Schwedt TJ, Dodick DW. Patent foramen ovale and migraine-bringing closure to the subject. Headache. 2006;46:663–71.

    Article  PubMed  Google Scholar 

  6. Downson A, Mullen MJ, Peatfield R, et al. Migraine Intervention with STARFlex Technology (MIST) trial: a prospective, multicenter, double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache. Circulation. 2008;117:1397–404. J Interv Cardiol. 2003;16:39–42.

    Google Scholar 

  7. •• Schwerzmann M, Meirer B. Impact of percutaneous patent foramen ovale closure on migraine course. Interv Cardiol. 2013;5:177–87. Thorough review of data on PFO and migraine.

    Google Scholar 

  8. Di Tullio M, Sacco RL, Venketasubramanian N, et al. Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke. 1993;24:1020–4.

    Article  PubMed  Google Scholar 

  9. Zito C, Dattillo G, Oreto G, et al. Patent foramen ovale: comparison among diagnostic strategies in cryptogenic stroke and migraine. Echocardiography. 2009;26:495–503.

    Article  PubMed  Google Scholar 

  10. Schwedt TJ, Demaerschalk BM, Dodick DW. Patent foramen ovale and migraine: a quantitative systemic review. Cephalalgia. 2008;28:531–40.

    Article  CAS  PubMed  Google Scholar 

  11. Garg P, Servoss SJ, Wu JC, et al. Lack of association between migraine headache and patent foramen ovale: results of a case-control study. Circulation. 2010;112:1406–12.

    Article  Google Scholar 

  12. Davis D, Gregson J, Willeit P, et al. Patent foramen ovale, ischemic stroke and migraine: systemic review and stratified meta-analysis of association studies. Neuroepidemiology. 2012;40:56–67.

    Article  PubMed  Google Scholar 

  13. Rundek T, Elkin MS, Di Tullio MR, et al. Patent foramen ovale and migraine: a cross-sectional study from the northern manhattan study (NOMAS). Circulation. 2008;118:1419–24.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Wilmshurst P, Nightingale S. Relationship between migraine and cardiac and pulmonary right-to-left shunts. Clin Sci. 2001;100:215–20.

    Article  CAS  PubMed  Google Scholar 

  15. Wilmshurst P, Pearson M, Nightingale S. Re-evaluation of the relationship between migraine and persistent foramen ovale and other right-to-left shunts. Clin Sci. 2005;108:365–7.

    Article  PubMed  Google Scholar 

  16. Schwerzmann M, Nedeltchev K, Lagger F, et al. Prevalence and size of directly detected patent foramen ovale in migraine with aura. Neurology. 2005;65:1415–8.

    Article  CAS  PubMed  Google Scholar 

  17. Anzola GP, Morandi E, Casilli F, Onorato E. Different degrees of right-to-left shunting predict migraine and stroke: data from 420 patients. Neurology. 2006;66:765–7.

    Article  PubMed  Google Scholar 

  18. Jesurum JT, Fuller CJ, Velez CA, et al. Migraineurs with patent foramen ovale have a larger right-to-left shunt on transcranial Doppler: a case control study. J Headache Pain. 2007;8:209–16.

    Article  PubMed Central  PubMed  Google Scholar 

  19. • van Gent MWF, Mager JJ, Snijder RJ, et al. Relation between migraine and size of echocardiographic intrapulmonary right-to-left shunt. J Cardiol. 2011;107:1399–404. Interesting study of migraine and shunt size.

    Article  Google Scholar 

  20. • Chambers J, Seed PT, Ridsdale L. Association of migraine aura with patent foramen ovale and atrial septal aneurysms. Int J Cardiol. 2013;168:3949–53. Sites incidence of PFO in patients with migraine.

    Article  PubMed  Google Scholar 

  21. • McCandless RT, Arrington CB, Nielsen DC, et al. Patent foramen ovale in children with migraine headaches. J Pediatr. 2011;159:243–7. Only article looking at PFO in children with migraine.

    Article  PubMed  Google Scholar 

  22. Zeller JA, Frahm K, Baron R, et al. Platelet-leukocyte interaction and platelet activation in migraine: a link to ischemic stroke? J Neurol Neurosurg Psychiatry. 2004;75:984–7.

    Article  CAS  PubMed  Google Scholar 

  23. Giardini A, Donti A, Formigari R, et al. Transcatheter patent foramen ovale closure mitigates aura migraine headaches abolishing spontaneous right-to-left shunting. Am Heart J. 2006;151:922.e1–5.

    Article  Google Scholar 

  24. Wilmshurst PT, Nightingale S, Walsh KP, Morrison WL. Clopidogrel reduces migraine with aura after transcatheter closure of persistent foramen ovale and atrial septal defects. Heart. 2005;91:1173–5.

    Article  CAS  PubMed  Google Scholar 

  25. Kaaro J, Partonen, Naik P, et al. Is migraine a lateralization defect? Neuroreport. 2008;19:1351–3.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Anzola GP, Frisoni GB, Morandi E, et al. Shunt-associated migraine responds favorably to atrial septal repair. A case-control study. Stroke. 2006;37:430–4.

    Article  PubMed  Google Scholar 

  27. Morandi E, Anzola GP, Angeli S, et al. Transcatheter closure of patent foramen ovale: a new migraine treatment? J Interv Cardiol. 2003;16:39–42.

    Article  PubMed  Google Scholar 

  28. Jesurum JT, Fuller CJ, Kim CJ, et al. Frequency of migraine headache relief following patent foramen ovale “closure” despite residual right-to-left shunt. Am J Cardiol. 2008;102:916–20.

    Article  PubMed  Google Scholar 

  29. Lutermans J, Post MC, Temmerman F, et al. Closure of patent foramen ovale is associated with a decrease in prevalence of migraine: a prospective observational study. Acta Cardiol. 2008;63:571–7.

    Article  Google Scholar 

  30. Schwerzmann M, Wiher S, Nedeltchev K, et al. Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks. Neurology. 2004;62:1399–401.

    Article  CAS  PubMed  Google Scholar 

  31. Post MC, Thijs V, Herroelen L, et al. Closure of patent foramen ovale is associated with a decrease in prevalence of migraine. Neurology. 2004;62:1439–40.

    Article  PubMed  Google Scholar 

  32. Reisman M, Chistofferson RD, Jesurum J, et al. Migraine headache relief after transcatheter closure of patent foramen ovale. J Am Coll Cardiol. 2005;45:493–5.

    Article  PubMed  Google Scholar 

  33. Slavin L, Tobis JM, Rangarajan K, et al. Five-year experience with percutaneous closure of patent foramen ovale. Am J Cardiol. 2007;99:1316–20.

    Article  PubMed  Google Scholar 

  34. Dubiel M, Brush L, Schmehl I, et al. Migraine headache relief after percutaneous transcatheter closure of interatrial communications. J Interv Cardiol. 2008;21:32–7.

    Article  PubMed  Google Scholar 

  35. Wilmshurst PT, Nightingale S, Walsh KP, et al. Effect on migraine of closure of cardiac right-to-left shunts to prevent recurrence of decompression illness or stroke or for haemodynamic reasons. Lancet. 2000;356:1648–51.

    Article  CAS  PubMed  Google Scholar 

  36. Azarbal B, Tobis J, Suh W, et al. Association of interatrial shunts and migraine headaches: impact of transcatheter closure. J Am Coll Cardiol. 2005;4:489–92.

    Google Scholar 

  37. •• Butera G, Biondi-Zoccai GG, Carminati M, et al. Systemic review and meta-analysis of currently available clinical evidence on migraine and patent foramen ovale percutaneous closure: much ado about nothing? Catheter Cardiovasc Interv. 2010;75:494–504. Only meta-analysis of PFO closure trials.

    PubMed  Google Scholar 

  38. Rigatelli G, Dell’Avvocata F, Ronco F, et al. Primary transcatheter patent foramen ovale closure is effective in improving migraine in patients with high-risk anatomic and functional characteristics for paradoxical embolism. JACC Cardiovasc Interv. 2010;3:282–7.

    Article  PubMed  Google Scholar 

  39. Rigatelli G, Dell’Avvocata F, Cardaioli P, et al. Improving migraine by means of primary transcatheter patent foramen ovale closure: long-term follow up. Am J Cardiovasc Dis. 2012;2:89–95.

    PubMed Central  PubMed  Google Scholar 

  40. Trabattoni D, Fabbiocchi F, Montosrsi P, et al. Sustained long-term benefit of patent foramen ovale closure on migraine. Catheter Cardiovasc Interv. 2011;77:570–4. Accessed 24 Dec 2013.

    Google Scholar 

  41. Khessali H, Mojadidi MK, Gevorgyan R, et al. The effect of patent foramen ovale closure on visual aura without headache or typical aura with migraine headache. JACC Cardiovasc Interv. 2012;5:682–7.

    Article  PubMed  Google Scholar 

  42. PREMIUM. http://clinicaltrials.gov/ct2/show/NCT00355056. Accessed 24 Dec 2013.

  43. PRIMA. http://www.clinicaltrials.gov/ct2/show/NCT00505570. Accessed 24 Dec 2013.

  44. MIST II. http://www.clinicaltrials.gov/ct2/show/NCT00283738. Accessed 24 Dec 2013.

  45. ESCAPE. http://www.clinicaltrials.gov/ct2/show/NCT0267371. Accessed 24 Dec 2013.

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Jessica Ailani declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jessica Ailani.

Additional information

This article is part of the Topical Collection on Headache

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ailani, J. Migraine and Patent Foramen Ovale. Curr Neurol Neurosci Rep 14, 426 (2014). https://doi.org/10.1007/s11910-013-0426-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-013-0426-4

Keywords

Navigation