Patent foramen ovale detected by near-infrared spectroscopy in patients suffering from migraine with aura

Abstract

There is an increased prevalence of patent foramen ovale (PFO) in women with migraine with aura (MwA) compared to controls, but the role of PFO in triggering aura is still debated. The aim of this study was to test a group of women suffering from MwA with nearinfrared spectroscopy (NIRS), to assess the NIRS capability of discriminating between subjects with and without PFO. Eighty-eight MwA patients (mean age 37.4±10.7 years, range 16–62 years) underwent NIRS measurement of the cerebral variations of the oxygenated (O₂Hb) and reduced haemoglobin (HHb) during breath-holding. The prevalence of O₂Hb vs. HHb was used to assess the presence of PFO. As a gold standard, the presence of PFO was assessed by transcranial Doppler sonography (TCD). At the TCD analysis 48 patients (55%) showed PFOs, 32 of which were permanent. NIRS correctly detected 36 subjects out of 40 without PFO, and 38 subjects out of 48 having PFO: sensitivity was 79%; specificity was 90%. All the false negatives were permanent shunts. MwA patients with PFO showed a delayed increase in the O₂Hb concentration and a reduced oxygenation with respect to subjects without PFO. NIRS is effective in identifying the presence of PFO in a MwA population, but TCD achieves better diagnostic performances. The NIRS provides additional information about the cerebral vasoreactivity and highlights substantial differences between patients with latent and permanent shunts that warrant further studies.