**Section 6**

**Patent Foramen Ovale** 

152 Atrial Septal Defect

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**10**

*USA* 

**Atrial Septal Defect/Patent Foramen**

Migraine headaches affect approximately 13% of US population, affecting women in a 3:1 ratio and with a 60–80% familial inheritance. Migraine is a relevant social health problem; in fact it significantly restricts the social life of those who are affected. Recently, migraine headache has been suspected to be a potential risk factor for stroke, particularly in women,

Onset of migraine is usually between the ages of 20–64, with over 80% having their first episode before age 30 and tends to decrease in middle age. Migraine with aura (MA) is a variant characterized by transient neurological visual, verbal, sensory or motor symptoms that last from five to sixty minutes. MA is also known as "classic migraine" though only

Increased frequency of patent foramen Ovale (PFO) in migraneurs was first reported in 1998

An increased prevalence between patent foramen Ovale (PFOs) and migraine exists but there is conflicting data of a causal relationship between these two conditions. It remains controversial whether cardiac screening and intervention provides a treatment benefit in migraneurs and is an area currently investigated for demonstrating clinical benefit of PFO closure. This topic is an intersection between the practice of primary care physicians, neurologists, and cardiologists on the best practice and management of patients with difficult to control migraines given the billions spent on physician visits and

Several mechanisms linking PFO to migraine have been hypothesized, including humoral causes (serotonin-platelet activation, aggregation, and embolism causing cortical spreading depression) and genetic causes (autosomal dominant inheritance with incomplete penetrance). The presence of a right to left shunt (RLS) may be the most potent trigger of migraine attacks with or without aura, and researchers have speculated that a large RLS

Diagnostic Modalities to evaluate the presence or absence of PFO in the migraine patients are another controversial subject. Mostly agree that the Trans –thoracic echocardiography is

may contribute to the high risk of ischemic stroke in migraneurs with PFO.

smokers and for those making use of oral contraception.

25% of migraneurs experience an aura.

in a case–control study.

pharmacotherapy.

**1. Introduction** 

**Ovale and Migraine Headache** 

Mohammed Tawfiq Numan *University of Texas, Houston, Texas* 
