The Journal of Headache and Pain

"European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

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Open Access

Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal characteristics

  • Jill T. Jesurum1Email author,
  • Cindy J. Fuller1,
  • Carles A. Velez1,
  • Merrill P. Spencer1,
  • Kimberly A. Krabill1,
  • William H. Likosky1,
  • William A. Gray1,
  • John V. Olsen1 and
  • Mark Reisman1
The Journal of Headache and PainOfficial Journal of the European Headache Federation20078:396

Received: 19 March 2007

Accepted: 25 July 2007

Published: 24 September 2007


The objective of the study was to assess differences in proportion of large right-to-left shunt (RLS) and atrial septal characteristics between migraineurs and non-migraineurs referred for transcatheter closure of patent foramen ovale (PF0). This retrospective study took place in a large metropolitan medical centre. The patients were migraineurs with aura (n=52), migraineurs without aura (n=19) and non-migraineurs (n=149). RLS was evaluated before closure using bilateral power m-mode transcranial Doppler at rest and after calibrated, sustained Valsalva manoeuvre, and graded with a validated 0–5 scale. Intracardiac echocardiography was used to assess atrial septal characteristics. Migraineurs had a higher proportion of large RLS (Grade IV or V) than nonmigraineurs at rest and after calibrated Valsalva (rest, p=0.04; Valsalva, p=0.01). Atrial septal characteristics were similar between groups. Migraine is associated with larger RLS at rest and strain; however migraine status does not predict PFO characteristics.


MigrainePatent foramen ovaleTranscranial Doppler