The Influence of Patent Foramen Ovale on the Clinical Features of Migraine without Aura: A Cross-Sectional Study

Abstract

Objective

To investigate the influence of patent foramen ovale (PFO) on the clinical features of migraine without aura (MoA).

Methods

We consecutively enrolled 390 MoA patients and compared the frequency of headache, episode duration, and the Visual Analogue Scale (VAS), Headache Impact Test 6 (HIT-6), and European Health Interview Survey-Quality of Life 8-item index (EUROHIS-QOL8) scores of patients with and without PFO, those with the mild right-to-left shunt (RLS) and moderate to large RLS, and those with permanent RLS and latent RLS using a nonparametric Mann–Whitney U-test. In addition, we analyzed the clinical features of migraine in 39 MoA patients before and after PFO closure treatment using the paired Wilcoxon test.

Results

The prevalence of PFO in the 390 MoA patients was 44.4%. Patients with PFO had significantly higher frequency of headaches, VAS scores, HIT-6 scores, and incidence of white matter lesions than those without PFO (all p< 0.05). Patients with moderate to large RLS had significantly higher VAS scores than those with mild RLS (p = 0.002). Additionally, 39 MoA patients underwent PFO closure, which remarkably decreased their frequency of headache, episode duration, VAS scores, and HIT-6 scores, and increased their EUROHIS-QOL8 scores.

Conclusion

The migraine features in MoA patients could be influenced by PFO, especially in patients with moderate to large shunt, in whom PFO closure improved the symptoms.

Keywords:

• migraine without aura
• patent foramen ovale
• clinical features
• closure treatment

Abbreviations

IQR, interquartile range; PFO, patent foramen ovale; HIT-6, Headache Impact test; VAS, Visual Analogue Scale; EUROHIS-QOL8, European Health Interview Survey-Quality of Life 8; WML, white matter lesions; MA, migraine with aura; MoA, migraine without aura; RLS, right to left shunt; PFO, patent foramen ovale; ICHD-III-beta, the International Classification of Headache Disorders; VM, Valsalva Maneuver; MRI, magnetic resonance imaging; cTTE, contrast transthoracic echocardiography; cTCD, contrast transcranial Doppler; MBs, microembolism.

Data Sharing Statement

All datasets presented in this study are included in the article material. The data supporting the results of this study are available from the corresponding author upon reasonable request from any qualified investigator.

Ethics Approval and Informed Consent

The study was conducted by the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University (No. KY2021-R064). Informed consent was obtained from participants or their legal representatives.

Consent for Publication

All authors approved the publishing of the final manuscript.

Acknowledgments

We are very grateful to all patients who participated in this study for their contributions. Thanks for the funding support of Wenzhou Municipal Scientific and Technological Program Projects (no. Y20210911).

Disclosure

The authors report no conflicts of interest in this work.