Juraj Dúbrava
Patent foramen ovale (PFO) is a risk factor for migraine. According to the metaanalysis it is found in up to 55 % of patients with migraine with aura. This prevalence is much higher than 19 % in patients without migraine. The occurrence of PFO in patients with migraine without aura – 25 % – is only slightly higher in comparison with patients without migraine. PFO is associated with migraine with aura but not with migraine without aura. Relation of PFO to migraine is most likely due to the „bypass“ of clearing capacity of the pulmonary endothelium in right-to-left shunt and increased concentration of the chemical substances (especially serotonin) to the brain. Several smaller nonrandomized studies have proved an important benefit of the percutaneous transcatheter closure of PFO in the prophylaxis of migraine. In migraine with aura the attacks disappeared in 34 - 100 % and in migraine without aura in 40 - 62 %. Until now only one randomized study (MIST) assessing the effect of transcatheter closure of PFO on the prevalence of migraine has been finished. Primary endpoint - complete elimination of headache after PFO closure - was not achieved. However, the closure significantly reduced the frequency of migraines attacks. Currently, percutaneous transcatheter closure of PFO is considered to be rational in migraine prohylaxis only in patients who have a history of stroke or transient ischemic attack.