Lack of Association Between Migraine Headache and Patent Foramen Ovale: Results of a Case-Control Study

Background— Clinical observations of migraine headache symptoms in patients with a patent foramen ovale (PFO), both of which conditions are highly prevalent, have raised the question of a possible pathophysiological relationship. We sought to evaluate the assumption of an association between migraine headaches and the presence of PFO by use of a large case-control study. Methods and Results— We conducted a case-control study to assess the prevalence of PFO in subjects with and without migraine. Case subjects were those with a history of migraine (diagnosed by neurologists at a specialty academic headache clinic). Control subjects were healthy volunteers without migraine 1:1 matched on the basis of age and sex with case subjects. Presence of PFO was determined by transthoracic echocardiogram with second harmonic imaging and transcranial Doppler ultrasonography during a standardized procedure of infused agitated saline contrast with or without Valsalva maneuver and a review of the results by experts blinded to case-control status. PFO was considered present if both studies were positive. Odds ratios were calculated with conditional logistic regression in the matched cohort (n=288). In the matched analysis, the prevalence of PFO was similar in case and control subjects (26.4% versus 25.7%; odds ratio 1.04, 95% confidence interval 0.62 to 1.74, P=0.90). There was no difference in PFO prevalence in those with migraine with aura and those without (26.8% versus 26.1%; odds ratio 1.03, 95% confidence interval 0.48 to 2.21, P=0.93). Conclusions— We found no association between migraine headaches and the presence of PFO in this large case-control study.

[1]  G E Tietjen,et al.  Migraine as a Systemic Vasculopathy , 2009, Cephalalgia.

[2]  P. Goadsby,et al.  Neurobiology of migraine , 2009, Neuroscience.

[3]  M. Ferrari,et al.  Migraine in the Triptan Era: Lessons From Epidemiology, Pathophysiology, and Clinical Science , 2009, Headache.

[4]  P. Goadsby.  The vascular theory of migraine--a great story wrecked by the facts. , 2009, Brain : a journal of neurology.

[5]  S. Silberstein.  Recent developments in migraine , 2008, The Lancet.

[6]  T. Kurth,et al.  Migraine: a matter of the heart? , 2008, Circulation.

[7]  D. Dodick,et al.  Patent Foramen Ovale and Migraine: A Quantitative Systematic Review , 2008, Cephalalgia : an international journal of headache.

[8]  A. Dowson,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 , 2008, Circulation.

[9]  L. Bruch,et al.  Migraine headache relief after percutaneous transcatheter closure of interatrial communications. , 2008, Journal of interventional cardiology.

[10]  R. Sacco,et al.  Patent Foramen Ovale and Migraine: A Cross-Sectional Study From the Northern Manhattan Study (NOMAS) , 2007, Circulation.

[11]  C. Kimmelstiel,et al.  Is patent foramen ovale closure effective in reducing migraine symptoms? A controlled study , 2007, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[12]  R. Sacco,et al.  Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. , 2007, Journal of the American College of Cardiology.

[13]  M. Schwerzmann,et al.  Patent foramen ovale closure: A new therapy for migraine , 2007, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[14]  R. Lipton,et al.  Migraine prevalence, disease burden, and the need for preventive therapy , 2007, Neurology.

[15]  V. Kudithipudi,et al.  Protocol for Optimal Detection and Exclusion of a Patent Foramen Ovale Using Transthoracic Echocardiography with Agitated Saline Microbubbles , 2006, Echocardiography.

[16]  G. Frisoni,et al.  Shunt-associated migraine responds favorably to atrial septal repair: a case-control study. , 2006, Stroke.

[17]  K. Ikeda,et al.  Cardiovascular risk factors and migraine: The GEM population-based study , 2005, Neurology.

[18]  P. Wilmshurst,et al.  Clopidogrel reduces migraine with aura after transcatheter closure of persistent foramen ovale and atrial septal defects , 2005, Heart.

[19]  J. Tobis,et al.  Association of interatrial shunts and migraine headaches: impact of transcatheter closure. , 2005, Journal of the American College of Cardiology.

[20]  J. V. Olsen,et al.  Migraine headache relief after transcatheter closure of patent foramen ovale. , 2005, Journal of the American College of Cardiology.

[21]  C. Machado.  Assessment: Transcranial Doppler ultrasonography: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology , 2004, Neurology.

[22]  J. De Sutter,et al.  Second harmonic transthoracic echocardiography: the new reference screening method for the detection of patent foramen ovale. , 2004, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[23]  Vinod Kumar Gupta,et al.  Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks , 2004, Neurology.

[24]  A. Kelion,et al.  Transthoracic echocardiography using second harmonic imaging with Valsalva manoeuvre for the detection of right to left shunts. , 2004, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[25]  A. Alexandrov,et al.  Assessment: Transcranial Doppler ultrasonography: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology* , 2004, Neurology.

[26]  V. Thijs,et al.  Closure of a patent foramen ovale is associated with a decrease in prevalence of migraine , 2004, Neurology.

[27]  S. Silberstein,et al.  Migraine , 1934, The Lancet.

[28]  W. Stewart,et al.  Migraine Disability Assessment (MIDAS) Score: Relation to Headache Frequency, Pain Intensity, and Headache Symptoms , 2003, Headache.

[29]  J. Coste,et al.  Clinical and Imaging Findings in Cryptogenic Stroke Patients With and Without Patent Foramen Ovale: The PFO-ASA Study , 2002 .

[30]  W. Stewart,et al.  Clinical Utility of an Instrument Assessing Migraine Disability: The Migraine Disability Assessment (MIDAS) Questionnaire , 2001, Headache.

[31]  R. Lipton,et al.  Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II , 2001, Headache.

[32]  I. Bone,et al.  Interatrial septal abnormalities and stroke , 2000, Neurology.

[33]  T. Cheng.  Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study , 1999 .

[34]  T. Cheng,et al.  Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. , 1999, Neurology.

[35]  J. Olesen,et al.  The relative role of genetic and environmental factors in migraine without aura , 1999, Neurology.

[36]  J. Olesen,et al.  Evidence of a genetic factor in migraine with aura: A population‐based Danish twin study , 1999, Annals of neurology.

[37]  Giorgio Ferriero,et al.  Migraine with Aura and Right-to-Left Shunt on Transcranial Doppler: A Case-Control Study , 1998, Cerebrovascular Diseases.

[38]  E. Fisher,et al.  The incidence of patent foramen ovale in 1,000 consecutive patients. A contrast transesophageal echocardiography study. , 1995, Chest.

[39]  B. Rasmussen,et al.  Migraine prevalence. A review of population-based studies. , 1994, Neurology.

[40]  W. Edwards,et al.  Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. , 1984, Mayo Clinic proceedings.