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Patent foramen ovale and migraine: an example of heart–brain interaction

Nature Clinical Practice Neurology volume 5, pages 20–21 (2009)Cite this article

The foramen ovale is a tunnel-like anatomical structure located in the interatrial wall of the fetal heart that enables right-to-left shunting during fetal development. In the majority of people this hole closes after birth; however, in about 30% of cases the hole remains open, or 'patent', and represents a potential substrate for right-to-left shunting during adult life.1 In recent years, patent foramen ovale (PFO) closure has been advocated as a treatment option for migraine because of an apparent link between the two conditions, but this approach is controversial. This article reviews, in brief, the strength of the relationship between PFO and migraine, with the aim of showing that a causal relationship between PFO and migraine with aura is biologically plausible, scientifically tenable and worthy of experimental testing.

The bulk of epidemiological data supports the link between migraine and PFO and furthermore indicates that the relationship between migraine and PFO is bidirectional—not only do migraineurs have an increased likelihood of having PFO (approximately twice that in the general population), but individuals with PFO also have an increased risk of migraine.2,3,4 The epidemiological association is largely limited to migraine with aura and tends not to include migraine without aura or tension-type headache.4 This observation suggests that this co-occurrence of migraine and PFO is more than coincidental and lends support to the hypothesis of a causal relationship.

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Author notes

  1. Neurology Service Ospedale Sant'Orsola-Fatebenefratelli, Via Vittorio Emanuele II, 27, 25100 Brescia, Italy gpanzola@fatebenefratelli.it

Authors and Affiliations

  1. GP Anzola is Head of the Neurology Service at Sant'Orsola-Fatebenefratelli Hospital, Brescia, Italy.,

    Gian Paolo Anzola

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  1. Gian Paolo Anzola
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The author declares no competing financial interests.

Supplementary information

Supplementary Table 1

Summary of the results of observational studies on the effect of patent foramen ovale closure on migraine (DOC 41 kb)

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Anzola, G. Patent foramen ovale and migraine: an example of heart–brain interaction. Nat Rev Neurol 5, 20–21 (2009). https://doi.org/10.1038/ncpneuro0969

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