Update advance in migraine and patent foramen ovale

Abstract

Migraine is a common neuro⁃vascular disease with a global prevalence of about 15% and a heavy burden. Patent foramen ovale (PFO) is the most common congenital cardiac abnormality consisting of the main cause of right⁃to⁃left shunt (RLS). There is a correlation between PFO and migraine, especially migraine with aura (MA). The comorbidity rate of PFO and migraine is significantly higher than that of the general population. The exact pathophysiological mechanism of comorbidity between PFO and migraine is unclear. At present, it is considered that paradoxical embolism and vasoactive peptides may underlie this comorbidity. Some studies suggest that percutaneous closure of PFO can reduce the frequency and duration of migraine, but the effectiveness of closure of PFO is still controversial. At present, limited evidence suggests that migraine with aura, antiplatelet drugs, large amount of RLS, and comorbid with ischemic stroke and transient ischemic attack (TIA) may benefit more from closure of PFO. In the future, more multicenter, prospective, double⁃blind, randomized controlled large⁃scale clinical studies are needed to clarify the long⁃term efficacy and predictive factors of closure of PFO on migraine prophylactic treatment, so as to provide criteria for screening the eligible patients treated with closure of PFO.

doi：10.3969/j.issn.1672⁃6731.2022.02.006