Clinical characteristics and short-term outcomes of migraine with patent foramen ovale: a comparative study.

OBJECTIVE

To analyze the clinical features and prognosis of migraine with PFO and explore their short-term prognostic factors.

METHODS

This study enrolled patients with migraine (MH) and patients with migraine with patent foramen ovale (MH-PFO) who were treated at two hospitals affiliated with Zunyi Medical University (December 2021-October 2022). The general information of the two groups of patients was compared, and the clinical characteristics of the patients with MH-PFO were analyzed. All participants underwent standardized follow-ups at 1 and 3 months posttreatment; the patients were assessed using the Headache Impact Test-6 (HIT-6), the Zung Self-Rating Anxiety Scale (SAS), and the Zung Self-Rating Depression Scale (SDS). Prognostic analysis included multivariate logistic regression.

RESULTS

239 patients with migraine completed the follow-up (MH group: 67; MH-PFO group: 172). Compared with the MH group, the MH-PFO group presented significantly earlier symptom onset (P < 0.001), a greater incidence of migraine aura (36.6% vs. 3.0%), a greater family history of migraine (28.5% vs. 9.0%), and elevated HIT-6/SAS/SDS scores and D-dimer levels (all P < 0.05). The medication response was poorer in the MH-PFO group (P < 0.05). Compared with medication, surgical intervention in the MH-PFO group reduced the severity of headache and anxiety/depression (all P < 0.05). Migraine with aura (1 month: OR = 0.159; 3 months: OR = 0.218), intrinsic right-to-left shunt (1 month: OR = 0.228; 3 months: OR = 0.060), and higher baseline HIT-6 scores (1 month: OR = 0.904; 3 months: OR = 0.879) were consistent predictors of reduced headache severity at the 1- and 3-month follow-ups postsurgery (all P < 0.05). A composite model integrating these factors demonstrated robust predictive accuracy for headache improvement after surgical treatment (AUC 0.84-0.89, P < 0.05; 0.7 < AUC < 0.9, all P < 0.05).

CONCLUSION

Compared to patients with MH, patients with MH-PFO have earlier symptom onset, higher rates of migraine aura, increased headache severity, more severe anxiety/depression, elevated D-dimer levels, and a greater incidence of family history of migraine. These patients respond more poorly to medication than patients with MH do. PFO closure has superior short-term efficacy in patients with migraine aura, intrinsic shunt, and high baseline HIT-6 scores (HIT-6 ≥ 59.5), highlighting the need for tailored therapeutic strategies.