Migraine is a common neurological condition. An association between patent foramen ovale (PFO) and migraine, particularly migraine with aura, has been observed in clinical studies and everyday practice.
At the same time, migraine is a multifactorial disorder, and the presence of a PFO does not automatically mean that migraine symptoms are caused by the PFO.
When migraine and PFO may be related
A potential link between migraine and PFO is most often discussed in patients with:
– Migraine with aura
– High-frequency or therapy-refractory migraine
– Additional clinical features suggesting right-to-left shunting
Even in these situations, careful evaluation is essential before attributing migraine symptoms to a PFO.
Is PFO closure a treatment for migraine?
PFO closure is not standard therapy for migraine.
However, in selected patients, PFO closure may be considered after careful interdisciplinary evaluation, particularly when:
– Migraine symptoms are severe and refractory to medical therapy
– A relevant PFO with significant right-to-left shunt is present
– Other potential migraine triggers have been addressed
In clinical practice, some patients report improvement of migraine symptoms after PFO closure, while others do not. Expectations must therefore be realistic and individualized.
Patients we frequently evaluate
We frequently see patients who:
– Have migraine and a known PFO and are seeking a second opinion
– Were told that PFO closure is “not indicated” without individualized assessment
– Have migraine in combination with other potential PFO-related conditions (e.g. prior embolic events, diving-related concerns)
Each case is evaluated individually, with transparent discussion of potential benefits and limitations.
Important considerations
Short-term changes in migraine frequency may occur after PFO closure, particularly after implantation of a metallic device. These effects are usually transient.
The choice of closure technique (device-based, suture-based, or bioresorbable) is based on anatomy, clinical context, and patient-specific factors.
Our approach
Decisions regarding PFO closure in patients with migraine are never made routinely.
We focus on careful patient selection, interdisciplinary discussion, and realistic counseling, rather than promising symptom relief.