The results of a study published in the October issue of Headache suggest a possible association between migraine with aura and patent foramen ovale.

"Patent foramen ovale is considered to have a role in migraine," which is supported by other clinical evidence, Dr. Izabela Domitrz, of Warsaw Medical University, Poland, and colleagues point out. "The relationship between migraine and patent foramen ovale may be stronger in patients suffering from migraine with aura compared to patients with common migraine."

The researchers examined the frequency of patent foramen ovale in patients with migraine with aura and compared it with the prevalence of patent foramen ovale in patients with migraine without aura (migraine without aura), and in a group of healthy, age-matched controls.

They evaluated the association of patent foramen ovale with types of migraine, frequency of attacks, familial occurrence, sex, and age in 121 migraine patients: 61 with migraine with aura, 60 with migraine without aura. They also evaluated 65 healthy controls.

Patients with migraine with aura were divided into subgroups according to the type of aura, and transcranial Doppler with contrast medium was performed during Valsalva maneuver to diagnose patent foramen ovale.

Patent foramen ovale was seen in 54% patients with migraine with aura, 25% with migraine without aura, and 25% of controls, a significant difference. No association was observed between patent foramen ovale and type of aura, frequency of attacks, familial occurrence, sex, and patient age.

"Higher prevalence of patent foramen ovale in our patients with migraine with aura might suggest that at least some attacks of migraine with aura may be associated with patent foramen ovale," Dr. Domitrz and colleagues explain.

"The mechanism of attacks of migraine in patients with patent foramen ovale remains unclear, but paradoxical embolism might provoke transient focal neurological symptoms by vasoconstriction, transient cerebral ischemia secondary to vasospasm (as a result of vascular changes postulated by some authors) or cortical spreading depression."

Headache 2007; 47:1311-1318.