Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.916
Peer-review started: July 24, 2018
First decision: October 8, 2018
Revised: October 14, 2018
Accepted: November 7, 2018
Article in press: November 7, 2018
Published online: December 6, 2018
Processing time: 135 Days and 23.2 Hours
The relationship between patent foramen ovale (PFO) with atrial septal aneurysm (ASA) and migraine remains controversial. We examined this association through an observational, single-center, case-controlled study.
A PFO with ASA has been identified as a risk factor for ischemic stroke. Patients with migraine with aura appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association between ASA and migraine in PFO closure patients has rarely been reported. Therefore, in addition to clarifying the relationship between PFO, ASA, and migraine, this study also hopes to provide guidance for the choice of migraine patients who can benefit more from PFO closure.
The research objective of this study was to test the potential association between ASA and migraine in PFO closure patients. Because ASA is a structural abnormality, our findings also verify the role of ASA in migraine with PFO patients. Further PFO and migraine studies should focus on the specific intra-atrial structural abnormality.
We retrospectively analyzed 450 migraineurs who had right-to-left shunts and underwent PFO closure from February 2012 to October 2016. The patients were classified into two groups according to whether they had ASA or not: the PFO with ASA group and the PFO without ASA group. This study is a single-center, non-randomized, case-controlled study.
Our research found that the PFO with ASA patients had an increased frequency of ischemic lesions and migraine with aura. The PFO size was significantly larger in PFO with ASA patients. However, there was no significant difference in Headache Impact Test-6 scores between the PFO with ASA and without ASA groups before and after the PFO closure. Given its nature, the present study shares all of the limitations of case-controlled studies. In our study, the mean follow-up time was only 1 years. Although the effect of PFO closure on migraine usually appears within this time frame, the results may have been affected. The small sample size is another limitation of this study.
This single-center, case-controlled study cohort, despite its small sample size, suggests that the prevalence of ASA with migraine in PFO patients is associated with ischemic stroke, larger patent foramen ovale size, and migraine with aura. That is to say, the presence/absence of an ASA is associated with differences in baseline characteristics but not with differences in severity of migraine as demonstrated by the similar score results.
We used the anatomical abnormality of ASA as a breakthrough point, and concluded that patients with ASA have a large PFO diameter and a high incidence of ischemic stroke and migraine with aura. According to our experience, the direction of the future research should focus on the anatomical abnormality of PFO. And we also believe that the highest level of evidence in clinical studies is still a multi-center, prospective, randomized controlled study.