title: Patent foramen ovale and migraine: a cross-sectional study from the Northern Manhattan Study (NOMAS).
abstract: BACKGROUND
  A causal relationship between patent foramen ovale (PFO) and migraine has been hypothesized, and improvement of migraine frequency and severity after percutaneous PFO closure has been reported. Population-based data on the relationship between PFO and migraine are sparse, however. The objective of this study was to examine the association between PFO and migraine among stroke-free individuals in an urban, population-based, multiethnic cohort.
  
  
  RESULTS
  As a part of the ongoing Northern Manhattan Study (NOMAS), 1101 stroke-free subjects were assessed for self-reported history of migraine. The presence of PFO was assessed by transthoracic echocardiography. The mean age of the group was 69+/-10 years; 58% were women. Forty-eight percent were Caribbean Hispanic, 24% were white, 26% were black, and 2% were another race/ethnicity. The prevalence of self-reported migraine was 16% (13% migraine with aura). The prevalence of PFO was 15%. Migraine was significantly more frequent among younger subjects, women, and Hispanics. The prevalence of PFO was not significantly different between subjects who had migraine (26/178, or 14.6%) and those who did not (138/923, or 15.0%; P=0.9). In an adjusted multivariate logistic regression model, the presence of PFO was not associated with increased prevalence of migraine (odds ratio 1.01, 95% confidence interval 0.63 to 1.61). Increasing age was associated with lower prevalence of migraine in both subjects with a PFO (odds ratio 0.94, 95% confidence interval 0.90 to 0.99 per year) and those without PFO (odds ratio 0.97, 95% confidence interval 0.95 to 0.99 per year). The observed lack of association between PFO and migraine (with or without aura) was not modified by diabetes mellitus, hypertension, cigarette smoking, or dyslipidemia.
  
  
  CONCLUSIONS
  In this multiethnic, elderly, population-based cohort, PFO detected with transthoracic echocardiography and agitated saline was not associated with self-reported migraine. The causal relationship between PFO and migraine remains uncertain, and the role of PFO closure among unselected patients with migraine remains questionable.
authors.affiliation: Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA. trundek@med.miami.edu
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Carrera
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D009519:New York City / Q000453:epidemiology; D012307:Risk Factors
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