title: Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study.
abstract: A patent foramen ovale (PFO) with atrial septal aneurysm (ASA) has been identified as a risk factor for cryptogenic stroke. Patients with migraine with aura (MA) appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association between MA and PFO with ASA has never been reported. We examined this association in a large observational study.
  
  
  
  Patients (>18 years) who underwent an agitated saline transesophageal echocardiography (cTEE) at our outpatient clinics within a timeframe of 4 years were eligible to be included. Before cTEE they received a validated headache questionnaire. Two neurologists diagnosed migraine with or without aura according to the International Headache Criteria. A total of 889 patients (mean age 56.4±14.3 years, 41.7% women) were included. A PFO was present in 23.2%, an isolated ASA in 2.7%, and a PFO with ASA in 6.9%. The occurrence of migraine was 18.9%; the occurrence of MA was 8.1%. The prevalence of PFO with ASA was significantly higher in patients with MA compared to patients without migraine (18.1% vs 6.1%; OR 3.72, 95% CI 1.86-7.44, P<0.001). However, a PFO without ASA was not significantly associated with MA (OR 1.50, 95% CI 0.79-2.82, P=0.21). Interestingly, a PFO with ASA was strongly associated with MA (OR 2.71, 95% CI 1.23-5.95, P=0.01).
  
  
  
  In this large observational study, PFO with ASA was significantly associated with MA only. PFO closure studies should focus on this specific intra-atrial anomaly.
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands rj.snijder@antoniusziekenhuis.nl.
authors.forename: Roel J R
authors.initials: RJ
authors.lastname: Snijder
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Justin G L M
authors.initials: JG
authors.lastname: Luermans
authors.affiliation: Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Albert H
authors.initials: AH
authors.lastname: de Heij
authors.affiliation: Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia.|Department of Neurology, Austin Health, Victoria, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Thijs
authors.affiliation: Department of Neurology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Schonewille
authors.affiliation: Department of Cardiology, University Health Network, Toronto, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Van De Bruaene
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Swaans
authors.affiliation: Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Werner I H L
authors.initials: WI
authors.lastname: Budts
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Martijn C
authors.initials: MC
authors.lastname: Post
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054087:Atrial Septum / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging; D006322:Heart Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000000981:diagnostic imaging / Q000209:etiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: atrial septal aneurysm; cerebrovascular disorders; echocardiography; heart septal defect; migraine; patent foramen ovale