Lack of association between migraine headache and patent foramen ovale: results of a case-control study.
BACKGROUND
Clinical observations of migraine headache symptoms in patients with a patent foramen ovale (PFO), both of which conditions are highly prevalent, have raised the question of a possible pathophysiological relationship. We sought to evaluate the assumption of an association between migraine headaches and the presence of PFO by use of a large case-control study.


RESULTS
We conducted a case-control study to assess the prevalence of PFO in subjects with and without migraine. Case subjects were those with a history of migraine (diagnosed by neurologists at a specialty academic headache clinic). Control subjects were healthy volunteers without migraine 1:1 matched on the basis of age and sex with case subjects. Presence of PFO was determined by transthoracic echocardiogram with second harmonic imaging and transcranial Doppler ultrasonography during a standardized procedure of infused agitated saline contrast with or without Valsalva maneuver and a review of the results by experts blinded to case-control status. PFO was considered present if both studies were positive. Odds ratios were calculated with conditional logistic regression in the matched cohort (n=288). In the matched analysis, the prevalence of PFO was similar in case and control subjects (26.4% versus 25.7%; odds ratio 1.04, 95% confidence interval 0.62 to 1.74, P=0.90). There was no difference in PFO prevalence in those with migraine with aura and those without (26.8% versus 26.1%; odds ratio 1.03, 95% confidence interval 0.48 to 2.21, P=0.93).


CONCLUSIONS
We found no association between migraine headaches and the presence of PFO in this large case-control study.
Division of Cardiology, Brigham and Women's Hospital, Boston, Mass 02115, USA.
Pallav
P
Garg
Stephen J
SJ
Servoss
Justina C
JC
Wu
Zahid H
ZH
Bajwa
Magdy H
MH
Selim
Alexis
A
Dineen
Richard E
RE
Kuntz
E Francis
EF
Cook
Laura
L
Mauri
D000328:Adult; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology* / Q000209:etiology; D016017:Odds Ratio; D015995:Prevalence; D017585:Ultrasonography, Doppler, Transcranial