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Patent foramen ovale and migraine: a quantitative systematic review.

Abstract

Initial studies indicate an increased prevalence of patent foramen ovale (PFO) in migraineurs with aura, and an increased prevalence of migraine and migraine with aura in persons with PFO. Retrospective analyses of PFO closure suggest clinically significant improvements in migraine patterns. The aim of this study was to examine the prevalence of migraine in patients with PFO, the prevalence of PFO in migraineurs, and the effect of PFO closure on migraine. We conducted a quantitative systematic review of articles on migraine and PFO that met inclusion criteria, then reviewed, appraised, and subjected them to data extraction. Of 134 articles identified, 18 met a priori selection criteria. The estimated strength of association between PFO and migraine, reflected by summary odds ratios (ORs), was 5.13 [95% confidence interval (CI) 4.67, 5.59], and between PFO and migraine with aura the OR was 3.21 (95% CI 2.38, 4.17). The grade of evidence was low. The association between migraine and PFO was OR 2.54 (95% CI 2.01, 3.08). The grade of evidence was low to moderate. Six studies of PFO closure suggested improvement in migraine, but had a very low grade of evidence. The low-to-moderate grade of evidence from observational studies supports an apparent association between PFO and migraine. Although PFO closure seemed to affect migraine patterns favourably, the very low grade of available evidence to support this association precludes definitive conclusions.

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  • Authors+Show Affiliations

    ,

    Washington University School of Medicine, Washington University Headache Center, St Louis, MO, USA.

    ,

    Source

    MeSH

    Clinical Trials as Topic
    Comorbidity
    Foramen Ovale, Patent
    Humans
    Migraine Disorders
    Prevalence
    Proportional Hazards Models
    Reproducibility of Results
    Risk Assessment
    Risk Factors
    Sensitivity and Specificity

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    18355348

    Citation

    Schwedt, T J., et al. "Patent Foramen Ovale and Migraine: a Quantitative Systematic Review." Cephalalgia : an International Journal of Headache, vol. 28, no. 5, 2008, pp. 531-40.
    Schwedt TJ, Demaerschalk BM, Dodick DW. Patent foramen ovale and migraine: a quantitative systematic review. Cephalalgia. 2008;28(5):531-40.
    Schwedt, T. J., Demaerschalk, B. M., & Dodick, D. W. (2008). Patent foramen ovale and migraine: a quantitative systematic review. Cephalalgia : an International Journal of Headache, 28(5), pp. 531-40. doi:10.1111/j.1468-2982.2008.01554.x.
    Schwedt TJ, Demaerschalk BM, Dodick DW. Patent Foramen Ovale and Migraine: a Quantitative Systematic Review. Cephalalgia. 2008;28(5):531-40. PubMed PMID: 18355348.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Patent foramen ovale and migraine: a quantitative systematic review. AU - Schwedt,T J, AU - Demaerschalk,B M, AU - Dodick,D W, Y1 - 2008/03/17/ PY - 2008/3/22/pubmed PY - 2008/5/22/medline PY - 2008/3/22/entrez SP - 531 EP - 40 JF - Cephalalgia : an international journal of headache JO - Cephalalgia VL - 28 IS - 5 N2 - Initial studies indicate an increased prevalence of patent foramen ovale (PFO) in migraineurs with aura, and an increased prevalence of migraine and migraine with aura in persons with PFO. Retrospective analyses of PFO closure suggest clinically significant improvements in migraine patterns. The aim of this study was to examine the prevalence of migraine in patients with PFO, the prevalence of PFO in migraineurs, and the effect of PFO closure on migraine. We conducted a quantitative systematic review of articles on migraine and PFO that met inclusion criteria, then reviewed, appraised, and subjected them to data extraction. Of 134 articles identified, 18 met a priori selection criteria. The estimated strength of association between PFO and migraine, reflected by summary odds ratios (ORs), was 5.13 [95% confidence interval (CI) 4.67, 5.59], and between PFO and migraine with aura the OR was 3.21 (95% CI 2.38, 4.17). The grade of evidence was low. The association between migraine and PFO was OR 2.54 (95% CI 2.01, 3.08). The grade of evidence was low to moderate. Six studies of PFO closure suggested improvement in migraine, but had a very low grade of evidence. The low-to-moderate grade of evidence from observational studies supports an apparent association between PFO and migraine. Although PFO closure seemed to affect migraine patterns favourably, the very low grade of available evidence to support this association precludes definitive conclusions. SN - 1468-2982 UR - https://www.unboundmedicine.com/medline/citation/18355348/full_citation L2 - http://journals.sagepub.com/doi/full/10.1111/j.1468-2982.2008.01554.x?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -