Liu Kaiming, Wang Brian Z, Hao Yishu, Song Shuijiang, Pan Mengxiong
Department of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China.
Nanyang Technological University Clinical Diagnostic Laboratory, NTU-Imperial Lee Kong Chian School of Medicine, Singapore, Singapore.
Front Neurol. 2020 Dec 1;11:543485. doi: 10.3389/fneur.2020.543485. eCollection 2020.
Migraine is a widespread neurological disorder. The patent foramen ovale (PFO) is a remnant of the fetal circulation. Multiple studies suggest that migraine is more prevalent in subjects with PFO and vice versa. It is unclear if there is a causal relationship or simply a co-existence of these two conditions. Furthermore, the treatment of migraine with percutaneous closure PFO remains controversial. We reviewed studies pertaining to the relationship between PFO and migraine as well as the effects of treatments on migraine attacks. We briefly summarized potential pathophysiological mechanisms of migraine, and elaborated on migraine type, frequency, and clinical symptoms of migraine with PFO and the clinical features of PFO with migraine. We also addressed the effects of PFO closure on migraine attacks. The evidence supports a "dose-response" relationship between migraine and PFO although more work needs to be done in terms of patient selection as well as the inclusion of an antiplatelet control group for PFO closure interventions to uncover possible beneficial results in clinical trials.
偏头痛是一种广泛存在的神经系统疾病。卵圆孔未闭（PFO）是胎儿循环的残余结构。多项研究表明，偏头痛在患有PFO的人群中更为普遍，反之亦然。目前尚不清楚这两种情况之间是存在因果关系还是仅仅共存。此外，经皮封堵PFO治疗偏头痛仍存在争议。我们回顾了有关PFO与偏头痛之间关系以及治疗对偏头痛发作影响的研究。我们简要总结了偏头痛潜在的病理生理机制，并阐述了偏头痛类型、频率、伴有PFO的偏头痛的临床症状以及伴有偏头痛的PFO的临床特征。我们还讨论了封堵PFO对偏头痛发作的影响。现有证据支持偏头痛与PFO之间存在“剂量反应”关系，不过在患者选择以及纳入抗血小板对照组以进行PFO封堵干预方面，还需要开展更多工作，以便在临床试验中发现可能的有益结果。
