Percutaneous patent foramen ovale closure in refractory migraine with aura: A case report with literature review and pathophysiological insights
Abstract
Patent foramen ovale (PFO), present in 20 – 30% of the population, is often asymptomatic but may allow right-to-left blood shunting that bypasses pulmonary filtration. This phenomenon has been implicated in cryptogenic stroke and migraine with aura, where microemboli or vasoactive substances may trigger cortical spreading depression. This work, through a clinical case, evaluates the role of percutaneous PFO closure in managing refractory migraine with aura by reviewing current evidence and pathophysiological mechanisms. Initially used for stroke prevention, PFO closure has been proposed as a compassionate treatment for refractory migraines. Although observational studies reported reductions in migraine frequency and severity, randomized trials have been inconsistent. Meta-analyses suggest benefits in specific subgroups, such as patients with aura, but heterogeneity limits conclusions. This case report presents the case of a 22-year-old patient with refractory migraine and a confirmed PFO who underwent successful percutaneous closure, achieving complete migraine remission, improved quality of life, and no evidence of residual shunting. Larger trials are needed to refine patient selection and validate guidelines.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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