Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Review Cerebrovasc Dis 2006;22:91–100 DOI: 10.1159/000093236 Migraine and Patent Foramen Ovale: A Residual Coincidence or a Pathophysiological Intrigue? B. Piechowski-Jozwiak a, b G. Devuyst a J. Bogousslavsky a a Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; b Department of Neurology, Medical University of Warsaw, Warsaw, Poland is largely symptomatic. Patent foramen ovale (PFO) is a highly prevalent remnant of fetal circulation that was shown to coexist with numerous brain disorders includ- ing migraine. The aim of this review was to inquire about epidemiological and pathophysiological evidence for the coexistence of these two entities based on the available literature. Classification and Epidemiology of Migraine When assessing epidemiological parameters of a spe- cific disorder, defining precise diagnostic criteria is of ba- sic importance. The criteria of the International Head- ache Society provide a platform for distinguishing be- tween different primary headache disorders. In the recent updated version of this classification, there are six major categories of migraine including migraine without aura, with aura and probable migraine (when one of the neces- sary diagnostic features is missing) (table 1) [1]. The com- plexity of the diagnosis is well illustrated by diagnostic criteria of migraine without aura. In a suspected case, there should be five or more attacks fulfilling the follow- ing criteria [2] : Key Words Migraine  Patent foramen ovale  Right-to-left shunting Abstract Migraine is one of the most common neurological disor- ders and one of the most frequent primary headaches. It imposes a significant burden on the affected individuals, society and health care system. As the etiology and pathophysiology of migraine are not well understood, treatment is largely symptomatic. Patent foramen ovale is a remnant of a fetal circulation and is highly prevalent in the general population. Its presence was linked to sev- eral disorders including migraine. The aim of this review was to search in the available data the answer to the question whether the link between migraine and patent foramen ovale is coincidental or whether they represent a pathophysiological entity. Copyright © 2006 S. Karger AG, Basel Migraine is one of the most frequent primary head- aches, and imposes an important burden on the affected individual and society. The etiology and pathophysiology of migraine are not fully understood and thus treatment Received: April 26, 2005 Accepted: January 24, 2006 Published online: May 9, 2006 Prof. Julien Bogousslavsky Department of Neurology CHUV CH–1011 Lausanne (Switzerland) Tel. +41 21 314 1220, Fax +41 21 314 1231, E-Mail julien.bogousslavsky@chuv.ch © 2006 S. Karger AG, Basel 1015–9770/06/0223–0091$23.50/0 Accessible online at: www.karger.com/ced