Patent foramen ovale with atrial septal aneurysm is strongly associated with migraine with aura: A large observational study

Background--a patent foramen ovale (pfo) with atrial septal aneurysm (asa) has been identified as a risk factor for cryptogenic stroke. patients with migraine with aura (ma) appear to be at risk for silent brain infarction,which might be related to the presence of a pfo. however,the association between ma and pfo with asa has never been reported. we examined this association in a large observational study. methods and results--patients (>18 years) who underwent an agitated saline transesophageal echocardiography (ctee) at our outpatient clinics within a timeframe of 4 years were eligible to be included. before ctee they 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 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<0.001). however,a pfo without asa was not significantly associated with ma (or 1.50,95% ci 0.79-2.82,p=0.21). interestingly,a pfo with asa was strongly associated with ma (or 2.71,95% ci 1.23-5.95,p=0.01). conclusion--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. © 2016 the authors.