The persistent foramen ovale and migraine

Percutaneous transcatheter patent foramen ovale closure with a GORE® CARDIOFORM Septal Occluder device via the right internal jugular venous approach

“…PFO is the most common defect of the heart, and it has been recognized as a source for cryptogenic stroke and migraine [5][6][7]. A relationship between PFOs and paradoxical embolisms has been documented previously in the literature, and the cause of stroke in a patient with a PFO is believed to be paradoxical embolism [3].…”

Patent Foramen Ovale and Migraine: Evidence for a Link?

“…A common developmental anomaly in endocardium and endothelium formation has been hypothesized that would lead, respectively, to PFO and endothelial dysfunction, 22 but there is no evidence so far that endothelium dysfunction plays a role in migraine. It seems more likely that there is a causal link between some large PFOs and some MA, 46 in other words that such MA are symptomatic, as reported in many other conditions, 1 particularly with arteriovenous shunts such as brain arteriovenous malformations, 2,9 leptomeningeal angiomatosis (Sturge–Weber syndrome), 47 and hereditary hemorrhagic telangiectasia 48 . This hypothesis is supported by observations of MA attacks occurring during Valsalva maneuver together with large amounts of contrast shunted from right‐to‐left as seen during TTE, 30,46 or occurring just after diving 28,30 or during sclerosing treatment of varicose veins in the legs 49 …”

“…This mechanism could account, besides gas embolism, for MA attacks postdiving. Bubbles may act as surfaces on which there is a potent platelet activation triggering platelet agregation and serotonin release 46 . Even under other circumstances, it is conceivable than serotonin, released in the venous circulation by platelet activation, instead of being eliminated by lung monoamine oxidase, reaches the brain in large amounts and triggers spreading depression.…”

“…Even under other circumstances, it is conceivable than serotonin, released in the venous circulation by platelet activation, instead of being eliminated by lung monoamine oxidase, reaches the brain in large amounts and triggers spreading depression. The exacerbation of MA observed in some patients after PFO closure 30,41,42 could be explained by platelet agregates with serotonin release forming on the left atrial part of the closure device until it becomes covered with endothelium 46 . The hypothesis that, in PFO, substances bypassing the lung filter may be better candidates to trigger attacks of MA than paradoxical emboli is supported by the occurrence of MA in other conditions with a right‐to‐left shunt 2,9,47,48 .…”

Migraine, patent foramen ovale and cardiovascular risks

“…Percutaneous closure of PFO, which is now preferred to surgical closure [12], has been shown to reduce the frequency of migraine [13][14][15][16][17][18][19], especially in those patients with migraine with aura [15,[18][19][20][21][22][23]. It seems logical, therefore, to adopt the same approach to reduce the risk of CVD in both men and women with migraine.…”