Migraine and patent foramen ovale: transesophageal echocardiography study. should we exclude migraine without aura?

The prevalence and size of patent foramen ovale [PFO] in migraine without aura have never been assessed directly using Transesophageal echocardiography [TEE] and compared with migraine with aura. We sought to assess the prevalence and the size of patent foramen ovale in patients suffering from migraine with [MA] and without [MoA] aura using TEE. consecutive patients with migraine with and without aura were asked to participate in the study. Impact of migraine on daily life was assessed using the Migraine Disability Assessment [MIDAS] questionnaire. Contrast transesophageal echocardiography was performed to all participants and the presence of a patent foramen ovale and their size were assessed. forty consecutive patients with migraine headache were included in our study. The majority of participants were women, mean age was 26.7 [18-38 year]. Family history of migraine was encountered in 65% of patients. The mean Migraine severity using MIDAS was 16.2 [5-28] half of the patients were higher than the score of 21. Out of the 40 studied patients, 18 [45%] showed patent foramen ovale in TEE examination. Twenty patients [50%] had migraine with aura. There was no statistical difference between MA and MoA patients regarding age, sex, and MIDAS. The prevalence of patent foramen ovale was significantly higher in MA patients 11 out of 20 [55%] compared with 7 out of 20 [35%] MoA patients [OR 2.7, p = 0.005]. The presence of PFO was significantly related to the migraine disability severity score. Large PFO size was found in 45% of patients with MA while 42% of patients with MoA [p = NS]. although prevalence of PFO is higher in migraine with aura, the prevalence of large PFO is nearly the same in both subtypes of migraine and more related to severity of migraine disability and family history of migraine