SHM Converge Scientific Abstract ePoster Gallery-A Hole Lot of Headache: When Pfo Triggers Migraine.

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This case report describes a 44-year-old woman with a history of migraines who presented with a sudden severe headache, visual symptoms, and numbness/tingling, prompting a stroke evaluation. Brain and spine CT scans were normal, and neurology diagnosed ocular migraine. Her symptoms improved with migraine-directed treatment.<br /><br />During further workup, a transthoracic echocardiogram showed a positive bubble study suggesting an intracardiac shunt. Transesophageal echocardiography confirmed a patent foramen ovale (PFO) with an atrial septal aneurysm and no intracardiac thrombus. After discussion with cardiology, she underwent successful percutaneous PFO closure with an Amplatzer device. Follow-up imaging showed no residual shunt, and at six months she reported complete resolution of her migraines.<br /><br />The report highlights the debated relationship between PFO and migraine. One proposed mechanism is that right-to-left shunting allows microemboli or vasoactive substances to bypass the pulmonary circulation and trigger cortical spreading depression, which may contribute to migraine aura. However, clinical evidence remains mixed. Some observational studies suggest migraine improvement after PFO closure, but randomized trials have been inconsistent. The PRIMA trial did not show a significant reduction in migraine days, while the PREMIUM trial showed only modest benefit, though complete remission occurred more often in the closure group.<br /><br />Overall, the authors emphasize that current guidelines do not recommend routine PFO closure for migraine treatment. Still, this case suggests that carefully selected patients with refractory migraine may experience substantial benefit, and further research is needed to identify who may respond best.

Asset Subtitle

Anjum Dhamani

Meta Tag

Author List Anjum Dhamani, Dipaben Patel, Kanza Maqsood, Sarah Misbah

Category Clinical Vignettes

Concept Patent Foramen Ovale

Concept Migraine

Concept Migraine with Aura

Concept Echocardiography

Concept PFO Closure

Distinguished Non-Finalist

Presenter Organization Mbbs,md

Presenting Author Anjum Dhamani

Track Adult

Keywords

patent foramen ovale

PFO closure

migraine

ocular migraine

atrial septal aneurysm

right-to-left shunt

bubble study

Amplatzer device

cortical spreading depression

stroke evaluation

Patent Foramen Ovale

Migraine

Migraine with Aura

Echocardiography

PFO Closure