Migraine and Patent Foramen Ovale

Headache (R Halker, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Headache


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.


Migraine Migraine with aura Visual aura Patent foramen ovale Patent foramen Ovale closure Right-to-left shunt 


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

  1. 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.PubMedCrossRefGoogle Scholar
  2. 2.
    Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders 3rd Edition (beta version). Cephalalgia. 2013;33:645–66.CrossRefGoogle Scholar
  3. 3.
    Weber F, Goriup A. Prevalence of right to-left shunts in active fighter pilots. Aviat Space Environ Med. 2007;78:135–6.PubMedGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 5.
    Schwedt TJ, Dodick DW. Patent foramen ovale and migraine-bringing closure to the subject. Headache. 2006;46:663–71.PubMedCrossRefGoogle Scholar
  6. 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. 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. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    Schwedt TJ, Demaerschalk BM, Dodick DW. Patent foramen ovale and migraine: a quantitative systemic review. Cephalalgia. 2008;28:531–40.PubMedCrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Wilmshurst P, Nightingale S. Relationship between migraine and cardiac and pulmonary right-to-left shunts. Clin Sci. 2001;100:215–20.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 25.
    Kaaro J, Partonen, Naik P, et al. Is migraine a lateralization defect? Neuroreport. 2008;19:1351–3.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 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.PubMedCrossRefGoogle Scholar
  29. 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.CrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 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.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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. 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.PubMedGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCentralPubMedGoogle Scholar
  40. 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. 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.PubMedCrossRefGoogle Scholar
  42. 42.
    PREMIUM. http://clinicaltrials.gov/ct2/show/NCT00355056. Accessed 24 Dec 2013.
  43. 43.
  44. 44.
  45. 45.

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Neurology, Georgetown Headache CenterGeorgetown University HospitalWashingtonUSA

Personalised recommendations