Study Shows That PFO With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura

December 9, 2016—A large observational study demonstrated that patent foramen ovale (PFO) with atrial septal aneurysm (ASA) is strongly associated with migraine with aura (MA). Roel JR Snijder, MD, et al published the findings online ahead of print in Journal of the American Heart Association (JAHA).

As summarized in JAHA, patients were eligible if they were older than age 18 and underwent an agitated saline transesophageal echocardiography (cTEE) at the researchers' outpatient clinics within a 4 year timeframe. Before cTEE the patients 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 investigators found that 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 < .001). However, a PFO without ASA was not significantly associated with MA (OR 1.5; 95% CI, 0.79‐2.82; P = .21); a PFO with ASA was strongly associated with MA (OR 2.71; 95% CI, 1.23‐5.95; P = .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, concluded the investigators in JAHA.