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

Figures & data

Figure 1 Flow diagram of participant enrollment.

Abbreviations: PFO, patent foramen ovale; MoA, Migraine without Aura; MRI, Magnetic Resonance Imaging; cTTE, contrast transthoracic echocardiography.

Table 1 Demographic and Clinical Characteristics of 390 MoA Patients

Variables	All Cases (n=390)	Data for Patients (n) with:
		PFO(+)(n=173)	PFO(-)(n=217)
Demographic characteristics				p-value
Female, n(%)	288 (73.8%)	135 (78%)	153 (70.5%)	0.093
Age (median[IQR]), yrs	43(35–49)	43(34–49)	44(36–51)	0.18
Family history, n(%)	227 (58.8%)^t	100 (58.1%)^u	127 (59.3%)^v	0.81
Hypertension, n(%)	32 (8.2%)	9 (5.2%)	23 (10.6%)	0.064
Diabetes, n(%)	7 (1.8%)	3 (1.7%)	4 (1.8%)	1
Hyperlipidemia, n(%)	36 (9.2%)	17 (9.8%)	19 (8.8%)	0.72
Clinical characteristics				Adjustp-value
Age of onset (median[IQR]), yrs	31(23–38.5)^a	30(23–37)^b	31(24–40)	0.24
Duration of disease (median[IQR]), yrs	10(5–16.5)^c	10(5–20)^d	10(5–15)	0.52
Frequency (median[IQR]), times/month	2.5(1–4)^e	2.5(1.5–4.5)^f	2(1–4)^g	0.002
Episode duration (median[IQR]), hours/time	24(6–24)^h	20(6–24)^i	24(5.5–24)^j	0.86
VAS Score (median[IQR])	7(6–8)^k	7(6–8)^l	6(5–8)^m	<0.001
EUROHIS-QOL 8 Score (median[IQR])	30(25–33)^n	29(26–32)^o	30(25–33.75)^p	0.5
HIT-6 Score (median[IQR])	62(56–68)^q	65(60–70)^r	61(54–65)^s	<0.001
WMLs, n(%)	113 (29%)	65 (37.6%)	48 (22.1%)	0.002

Notes: ^aThe number of all cases was 389 because 1 case was unknown; ^bThe number of all cases was 172 because 1 case was unknown; ^cThe number of all cases was 389 because 1 case was unknown; ^dThe number of all cases was 172 because 1 case was unknown, ^eThe number of all cases was 386 because 4 case was unknown; ^fThe number of all cases was 172 because 1 case was unknown; ^gThe number of all cases was 214 because 3 case was unknown; ^hThe number of all cases was 385 because 5 case was unknown; ⁱThe number of all cases was 172 because 1 case was unknown; ^jThe number of all cases was 213 because 4 case was unknown; ^kThe number of all cases was 374 because 16 case was unknown; ^lThe number of all cases was 168 because 5 case was unknown; ^mThe number of all cases was 208 because 9 case was unknown; ⁿThe number of all cases was 374 because 16 case was unknown; ^oThe number of all cases was 168 because 5 case was unknown; ^pThe number of all cases was 208 because 9 case was unknown; ^qThe number of all cases was 374 because 16 case was unknown; ^rThe number of all cases was 168 because 5 case was unknown; ^sThe number of all cases was 208 because 9 case was unknown;^tThe number of all cases was 386 because 4 case was unknown; ^uThe number of all cases was 172 because 1 case was unknown; ^vThe number of all cases was 214 because 3 case was unknown.

Abbreviations: n, number; yrs, years; 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; WMLs, white matter lesions.

Table 2 Demographic and Clinical Characteristics in Different RLS Among 133 MoA Patients with PFO

Variables	Small RLS (n=96)	Moderate to Large RLS (n=37)
Demographic characteristics			p-value
Female, n(%)	74(77.1)	29(78.4)	0.81
Age (median[IQR]), yrs	44(35–49)	42(34–49)	0.53
Family history, n(%)	51(53.7)^a	27(73.0)	0.05
Hypertension, n(%)	6(6.3)	0(0)	0.19
Diabetes, n(%)	3(3.1)	0(0)	0.56
Hyperlipidemia, n(%)	10(10.4)	5(13.5)	0.76
Clinical characteristics			Adjustp-value
Age of onset (median[IQR]), yrs	31(24–41)^b	29(23–38)	0.8
Duration of disease (median[IQR]), yrs	10(5–10)^c	10(4–20)	0.59
Frequency (median[IQR]), times/month	2.5(1.5–4.5)^d	3(2–5)	0.68
Episode duration (median[IQR]), hours/time	24(6–24)^e	18(5–24)	0.8
VAS Score (median[IQR])	7(6–8)^h	8(7–9)	0.016
EUROHIS-QOL 8 Score (median[IQR])	30(26–32)^g	30(25.5–34)	0.67
HIT-6 Score (median[IQR])	65(59–70)^f	67(61.5–70)	0.54
WMLs, n(%)	39(40.6)	13(35.1)	0.79

Notes: ^aThe number of all cases was 95 because 1 case was unknown;^bThe number of all cases was 95 because 1 case was unknown; ^cThe number of all cases was 95 because 1 case was unknown; ^dThe number of all cases was 95 because 1 case was unknown; ^eThe number of all cases was 95 because 1 case was unknown; ^fThe number of all cases was 93 because 3 cases was unknown; ^gThe number of all cases was 93 because 3 cases was unknown; ^hThe number of all cases was 93 because 3 cases was unknown.

Abbreviations; n, number; yrs, years; IQR, interquartile range; HIT-6, Headache Impact test; VAS, Visual Analogue Scale; EUROHIS-QOL8, European Health Interview Survey-Quality of Life 8;WMLs, white matter lesions.

Table 3 Demographic and Clinical Characteristics in Different PFO Status Among 173 MoA Patients with PFO

Variables	Latent (n=130)	Permanent (n=43)
Demographic characteristics			p-value
Female, n(%)	106(81.5)	29(67.4)	0.059
Age (median[IQR]), yrs	41.5(33–47)	47(39–51)	0.014
Family history, n(%)	80(61.5)^a	20(46.5)	0.11
Hypertension, n(%)	6(4.6)	3(7.0)	0.69
Diabetes, n(%)	1(0.8)	2(4.7)	0.15
Hyperlipidemia, n(%)	10(7.7)	7(16.3)	0.14
Clinical characteristics			Adjustp-value
Age of onset (median[IQR]), yrs	29(22–36)^b	31(26–40)	0.41
Duration of disease (median[IQR]), yrs	10(5–20)	10(6–20)	1
Episode duration (median[IQR]), hours/time	24(9.5–24)^c	18(4–24)	1
Frequency (median[IQR]), times/month	2.5(1.5–4.5)^d	3(1–8)	1
VAS Score (median[IQR])	7(6–8)^e	8(7–8)	1
EUROHIS-QOL8 Score (median[IQR])	29(26–32)^f	27(25–32)	1
HIT-6 Score (median[IQR])	65 (60–70)^g	66(59–70)	0.99
WMLs, n(%)	47/130(36.2%)	18/43(41.9%)	0.94

Notes: ^aThe number of all cases was 129 because 1 case was unknown;^bThe number of all cases was 129 because 1 case was unknown; ^cThe number of all cases was 129 because 1 case was unknown; ^dThe number of all cases was 129 because 1 case was unknown; ^eThe number of all cases was 126 because 4 cases was unknown; ^fThe number of all cases was 126 because 4 cases was unknown; ^gThe number of all cases was 126 because 4 cases was unknown.

Abbreviations: IQR, interquartile range; HIT-6, Headache Impact test; VAS, Visual Analogue Scale; EUROHIS-QOL8, European Health Interview Survey-Quality of Life 8; WMLs, white matter lesions.

Table 4 Demographic and Clinical Characteristics of 39 Patients with MoA for PFO Closure

Variables	Patients with MoA (n=39)
Female, n(%)	25(64.1)
Age (median[IQR]), yrs	42(33–49)
Family history, n(%)	20(51.2)
Hypertension, n(%)	4(10.3)
Diabetes, n(%)	1(2.6)
Hyperlipidemia, n(%)	11(28.2)
Age of onset (median[IQR]), yrs	25(19–31)
Duration of disease (median[IQR]), yrs	12(6–22)

Abbreviations: n, number; yrs, years; IQR, interquartile range.

Figure 2 The effects of migraine headaches after PFO closure in 39 MoA patients. (A) Episode duration, frequency, VAS, HIT-6 and EUROHIS-QOL 8 scores before and after PFO closure in 39 MoA patients; (B) The reduction of migraine days per month after PFO closure compared to before closure; (C) The reduction of frequency of migraine per month after PFO closure compared to before closure.