Patent foramen ovale linked to migraine with aura in children

There is a significantly higher incidence of patent foramen ovale (PFO) in children with migraine with aura than in children without aura or compared with the general population, according to a study in the Journal of Pediatrics.

Studies of adults with migraine with aura previously have found a higher incidence of PFO, ranging from 41% to 62%. However, no such studies had been conducted in children. Approximately 15% of children experience migraines, and about one-third of these have migraines with aura.

Investigators studied 109 children aged 6 to 18 years with migraine diagnosed in 2008 and 2009 at the Primary Children’s Medical Center in Salt Lake City, Utah. The children were evaluated for PFO and the relationship between the amount of right-to-left atrial shunting and migraine subtype. In the group, 35% had migraine with aura and 65% without aura. Color-flow Doppler scanning, saline solution contrast transthoracic echocardiography, and contrast transcranial Doppler scanning were performed.

The incidence of PFO was 35%, which is similar to the general population (25%). Children with aura had roughly double the rate of PFO than children without aura (50% vs 27%). There was no association between atrial shunt size and migraine with or without aura.

“These data suggest that PFO may contribute to the pathogenesis of migraine with aura in children and have implications for clinical decision making,” the researchers conclude.

The growing number of studies illustrating a link between PFO and adults with migraine with aura has generated increased interest in PFO closure therapy as a treatment for migraine, especially in those who have failed traditional medical management, add the researchers. Although there is a lack of evidence that supports PFO closure as a safe and effective migraine treatment, many children have been referred to their institution for evaluation and PFO closure.

McCandless RT, Arrington CB, Nielsen DC, Bale JF Jr, Minich LL. Patent foramen ovale in children with migraine headaches. J Pediatr. 2011. Epub ahead of print.