Service of Neurology, University Hospital "Central de Asturias" and INEUROPA, Oviedo, Spain.
Geisel School of Medicine at Darmouth, Hanover, NH, USA.
Headache. 2016 Oct;56(9):1466-1473. doi: 10.1111/head.12945. Epub 2016 Sep 16.
Pathophysiology of migraine is not fully known. A link has been proposed between migraine and patent foramen ovale (PFO). However, there are conflicting data regarding the causal relationship between PFO and migraine.
To test a potential association between migraine frequency and PFO by way of an observational, single-center, case-controlled study.
We studied a total of 130 chronic migraine (CM) and 53 episodic migraine (EM) patients. Transcranial Doppler with agitated saline injection was used to evaluate the presence and degree of PFO. PFO was judged to be present if any signal was detected. The degree of PFO during rest and Valsalva was quantified as follows: small (1-10 microbubbles [MB]), medium (10-25 MB), or large (>25 MB with shower or curtain pattern). PFO detected at rest were considered permanent, while those detected during Valsalva maneuver were classified as latent.
The prevalence of PFO was similar in CM and EM patients (53.1% [44.1-62.2] vs 54.7% [40.3-69.1], P = .871). PFO size was significantly larger in the EM group compared to the CM group (35.8% vs 20.3%, P = .037). The presence of permanent PFO was also significantly higher in EM compared to CM (37.7% vs 22.7%, P = .044). No differences were found according to the presence of aura.
This study indicates that PFO is not more common or larger in CM than in EM patients. These findings do not support a relationship between PFO and migraine frequency.
偏头痛的病理生理学尚未完全阐明。有人提出偏头痛与卵圆孔未闭（PFO）之间存在关联。然而，关于 PFO 与偏头痛之间的因果关系，目前仍存在相互矛盾的数据。
通过观察性、单中心、病例对照研究，检测偏头痛发作频率与 PFO 之间的潜在关联。
我们共研究了 130 例慢性偏头痛（CM）患者和 53 例发作性偏头痛（EM）患者。使用经颅多普勒超声（TCD）结合微泡声学造影（ agitated saline injection ）评估 PFO 的存在及其严重程度。如果检测到任何信号，则认为存在 PFO。在静息和瓦氏动作（Valsalva）时，PFO 的程度被量化为小（1-10 微泡[MB]）、中（10-25 MB）或大（>25 MB 伴幕帘样或雨点样）。静息时检测到的 PFO 被认为是永久性的，而在瓦氏动作时检测到的 PFO 则被归类为潜在性的。
CM 和 EM 患者的 PFO 发生率相似（53.1%[44.1-62.2] vs 54.7%[40.3-69.1]，P=0.871）。EM 组的 PFO 大小明显大于 CM 组（35.8% vs 20.3%，P=0.037）。永久性 PFO 的存在在 EM 患者中也明显高于 CM 患者（37.7% vs 22.7%，P=0.044）。有无先兆对结果没有影响。
本研究表明，PFO 在 CM 患者中并不比 EM 患者更常见或更大。这些发现不支持 PFO 与偏头痛发作频率之间存在关联。
