Is there a connection between PFO (patent foramen ovale) and migraine?

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Last updated: September 21, 2026 • View editorial policy

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Yes, there is a well-established connection between PFO and migraine, particularly migraine with aura.

Patent foramen ovale (PFO) occurs significantly more frequently in patients with migraine compared to the general population, with the strongest association seen in migraine with aura. This relationship appears to follow a "dose-response" pattern, where larger shunts and more severe PFO characteristics correlate with more frequent and severe migraine attacks 1.

The Evidence for Association

Prevalence Data

Multiple studies demonstrate that:

  • PFO prevalence is substantially elevated in migraine patients, especially those with aura
  • The relationship is bidirectional: migraine is more common in PFO patients, and PFO is more common in migraine patients 2, 1
  • High-risk PFO features (such as prominent Eustachian valve or Chiari valve) show even stronger associations with migraine 2

Neuroimaging Evidence

Recent functional MRI studies reveal specific brain changes in patients with both conditions:

  • The presence of PFO in migraine patients affects functional connectivity within and across multiple brain networks 3
  • PFO influences visual, auditory, default mode, dorsal attention, and salience networks 3
  • Structural changes occur in subcortical regions, deep white matter, and posterior circulation territories 4
  • Functional alterations appear in the cerebellum and colliculus, areas involved in pain processing and transmission 4

Proposed Mechanisms

Four main pathophysiological mechanisms explain the PFO-migraine connection:

  1. Microemboli-triggered cortical spreading depression (CSD): Small emboli passing through the PFO may trigger the cortical spreading depression that underlies migraine aura 4, 1

  2. Vasoactive substance hypothesis: Right-to-left shunting allows vasoactive substances (normally metabolized in the lungs) to reach cerebral circulation, potentially triggering migraine 4, 1

  3. Impaired cerebral autoregulation: PFO disrupts normal cerebral blood flow regulation 4

  4. Common genetic basis: Shared genetic factors may predispose to both conditions 4

Clinical Implications

Important Caveats

  • Not all migraine patients with PFO require closure 2
  • The relationship may represent correlation rather than pure causation in many cases 1
  • Consider closure primarily when:
    • High-risk PFO features are present
    • There are additional indications (such as cryptogenic stroke)
    • Migraine is refractory to medical management 2

Stroke Risk Consideration

Patients with both migraine and PFO face increased stroke risk, particularly:

  • Women with migraine with aura
  • Those with high-risk PFO anatomical features
  • Patients showing white matter lesions on MRI 2

However, PFO closure for migraine alone remains controversial and should not be performed routinely outside of clinical trials or specific high-risk scenarios 1, 5. The evidence for therapeutic benefit from closure is still evolving, and more rigorous randomized controlled trials with antiplatelet control groups are needed 1.

The connection is real and measurable through both clinical association studies and advanced neuroimaging, but the therapeutic implications remain an area requiring further investigation before widespread intervention can be recommended.

References

5
Research

Advances in the Study of the Correlation Between Patent Foramen Ovale and Migraine.

Psychiatry and clinical psychopharmacology, 2024

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.