Frequency of patent foramen ovale in migraine patient with aura versus migraine patient without aura in outpatient department of tertiary care hospital
DOI:
https://doi.org/10.59736/IJP.24.02.1080Keywords:
Headache, Migraine, Patent foramen ovaleAbstract
Background: Migraine is a highly prevalent neurological disorder and a leading cause of disability worldwide. Patent foramen ovale (PFO) has been implicated in the pathogenesis of migraine, particularly migraine with aura; however, evidence from Pakistan remains scarce. This study aimed to compare the frequency of PFO between patients with migraine with aura (MA) and those with migraine without aura (MOA) attending a tertiary care hospital.
Methods: This comparative cross-sectional study was conducted at the Department of Neurology, Pak Emirates Military Hospital (PEMH) Rawalpindi, from Jan/2025 to June/2025, including 68 patients, classified into two groups according to migraine type: Group A (MA, n=36) and Group B (MOA, n=36). All participants underwent contrast-enhanced transthoracic echocardiography for assessment of PFO. Data was analyzed through SPSS-24. Chi-square / Fisher’s Exact test was used, keeping p value<0.05 as significant.
Results: Mean age and headache duration were comparable between groups. The prevalence of PFO was significantly higher in the MA group than in the MOA group (41.7% vs. 11.1%; p=0.003). The distribution of PFO categories also differed significantly between the groups (p=0.013). No significant differences were observed between the groups regarding age distribution, gender, family history of migraine, or headache severity (all p>0.05). Additionally, PFO status was not significantly associated with age, gender, or headache severity.
Conclusion: Patients who had migraine with aura had significantly higher frequency of PFO compared to those without aura.
References
Chen ZF, Kong XM, Yang CH, Li XY, Guo H, Wang ZW. Global, regional, and national burden and trends of migraine among youths and young adults aged 15–39 years from 1990 to 2021: findings from the Global Burden of Disease Study 2021. J Headache Pain. 2024;25(1):131. doi:10.1186/s10194-024-01832-0.
Li Y, Hu N, Fan B, Wang X, Mao P, Zhang Y, Li Y. Rising global burden of migraine among adolescents and young adults: a 30-year analysis (1990–2021). Front Neurol. 2025;16:1652468. doi:10.3389/fneur.2025.1652468.
Alpert JS. Strange bedfellows: migraine headache and patent foramen ovale. Am J Med. 2021;134(11):1307-8.
Dalla Volta G, Guindani M, Zavarise P, Griffini S, Pezzini A, Padovani A. Prevalence of patent foramen ovale in a large series of patients with migraine with aura, migraine without aura and cluster headache, and relationship with clinical phenotype. J Headache Pain. 2005;6(4):328-30.
Cao W, Shen Y, Zhong J, Chen Z, Wang N, Yang J. The patent foramen ovale and migraine: associated mechanisms and perspectives from MRI evidence. Brain Sci. 2022;12(7):941. https://doi.org/10.3390/brainsci12070941
Wang YL, Wang FZ, Zhang Y, Jiang J, Jia Z, Liu X, et al. Association of migraine with patent foramen ovale closure: a systematic review and meta-analysis. Int J Cardiol Heart Vasc. 2022;39:100992. https://doi.org/10.1016/j.ijcha.2022.100992
Çelik SE, Anadol Ü, Forta H. Prevalence of patent foramen ovale in patients with migraine. Agri. 2007;19(4):39-42.
Liu K, Wang BZ, Hao Y, Song S, Pan M. The correlation between migraine and patent foramen ovale. Front Neurol. 2020;11:https://doi.org/10.3389/fneur.2020.543485
Reisman M, Fuller CJ. Is patent foramen ovale closure indicated for migraine? Patent foramen ovale closure for migraine. Circ Cardiovasc Interv. 2009;2(5):468-74.
Zuo Y, Wang J, Gong Z, Liu F, Liu T. Advances in the study of the correlation between patent foramen ovale and migraine. Psychiatry Clin Psychopharmacol. 2024;34(3):265-71. doi: 10.5152/pcp.2024.23810
Tang Y, Sun H, Plummer C, Vogrin SJ, Li H, Li Y, et al. Association between patent foramen ovale and migraine: evidence from a resting-state fMRI study. Brain Imaging Behav. 2024;18(4):720-9. https://doi.org/10.1007/s11682-024-00868-9
Tang Y, Peng A, Peng B, He S, Zhao X, Zhu Y, et al. Association between patent foramen ovale and migraine without aura: a community-based cross-sectional study in China. BMJ Open. 2022;12(3):e056937.
Zhang Y, Wang H, Liu L. Patent foramen ovale closure for treating migraine: a meta-analysis. J Interv Cardiol. 2022;2022:6456272.
Belopasova AV, Chechetkin AO, Merezhko VD. Patent foramen ovale and migraine in ischemic stroke patients: incidence, pathogenetic interrelation and the effects of endovascular closure. J Clin Pract. 2024;15(3):49-59.
Dong B, Li X, Zhang L, Liang G, Zheng W, Gui L, et al. Effects of patent foramen ovale in migraine: a metabolomics-based study. J Physiol. 2025;603(4):809-35. https://doi.org/10.1113/JP286772
Badea RȘ, Grecu N, Ribigan AC, Antochi F, Tiu C, Popescu BO. Headache patterns in patent foramen ovale patients: beyond migraine with aura. J Neural Transm (Vienna). 2024;131(7):755-61. https://doi.org/10.1007/s00702-024-02760-8
Sun Y, Huang N, Feng F, Xie Y, Xu T, Sun Y, et al. Clinical characteristics and short-term outcomes of migraine with patent foramen ovale: a comparative study. Eur J Med Res. 2025;30(1):1-13. https://doi.org/10.1186/s40001-025-02645-w
Lei X, Wei M, Qi Y, Wang L, Liu C, Guo Y, et al. The patent foramen ovale may alter migraine brain activity: a pilot study of electroencephalography spectrum and functional connectivity analysis. Front Mol Neurosci. 2023;16:1133303.
Mas JL, Guillon B, Charles-Nelson A, Domigo V, Derex L, Massardier E, et al. Patent foramen ovale closure in stroke patients with migraine in the CLOSE trial: the CLOSE-MIG study. Eur J Neurol. 2021;28(8):2700-7. https://doi.org/10.1111/ene.14892
Zhang QQ, Lu JJ, Yan MY, Hu XW, Qin YR, Wang DP, et al. The efficacy of percutaneous patent foramen ovale closure on migraine: a meta-analysis of randomized controlled trials and observational studies. Biomed Res Int. 2021;2021:6643266.
Hou S, Zhan Z, Fan J, Li M, Chen S, Zhang Y, et al. Association of in situ thrombus within the patent foramen ovale and patients with migraine: a prospective cohort study. Heliyon. 2024;10(11):e32105.
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