Recent epidemiologic data suggest a bidirectional link between patent foramen ovale (PFO) and migraine with aura (A) with a relative risk of 2 for PFO in subjects with MA and for MA in subjects with PFO. There is no evidence for a link between PFO and migraine without aura. This link is not systematic and applies only to subsets of PFO, mostly large defects, and to subsets of patients with MA. Although co-morbidity cannot be ruled out, it may be that this link is partly causal and that some large PFOs may favor MA attacks in genetically prediposed subjects, by allowing vasoactive substances, platelet emboli or paradoxical emboli to by-pass the lung filter to trigger cortical spreading depression responsible for aura.
The first double-blind randomized trial of PFO closure in refractory MA, «MIST» has failed to show any benefit in terms of primary efficacy or cessation of attacks during the analysis period of 3 to 6 months after the closure procedure.
There is thus at present no indication to search for PFO or to close PFO in migraine patients.
© 2007 Elsevier Masson SAS. Tous droits réservés.