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Objective <p>To analyze the clinical features and prognosis of migraine with PFO and explore their short-term prognostic factors.</p> Methods <p>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&#xa0;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.</p> Results <p>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 (<i>P</i> &lt; 0.001), a greater incidence of migraine aura (36.6% vs. 3.0%), a greater family history of migraine (28.5% vs<i>.</i> 9.0%), and elevated HIT-6/SAS/SDS scores and D-dimer levels (all <i>P</i> &lt; 0.05). The medication response was poorer in the MH-PFO group (<i>P</i> &lt; 0.05). Compared with medication, surgical intervention in the MH-PFO group reduced the severity of headache and anxiety/depression (all <i>P</i> &lt; 0.05). Migraine with aura (1&#xa0;month: OR = 0.159; 3&#xa0;months: OR = 0.218), intrinsic right-to-left shunt (1&#xa0;month: OR = 0.228; 3&#xa0;months: OR = 0.060), and higher baseline HIT-6 scores (1&#xa0;month: OR = 0.904; 3&#xa0;months: OR = 0.879) were consistent predictors of reduced headache severity at the 1- and 3-month follow-ups postsurgery (all <i>P</i> &lt; 0.05). A composite model integrating these factors demonstrated robust predictive accuracy for headache improvement after surgical treatment (AUC 0.84–0.89, <i>P</i> &lt; 0.05; 0.7 &lt; AUC &lt; 0.9, all <i>P</i> &lt; 0.05).</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月20日

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  • Yongfei Sun,
  • Nanqu Huang,
  • Fei Feng,
  • Yiman Xie,
  • Tao Xu,
  • Yuekui Sun,
  • Yong Luo,
  • Jian Zhan

摘要

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.