Work

Preliminary exploration of the pathogenesis of patent foramen ovale-related migraine and efficacy analysis of PFO closure

Year: 2026

Type: article

Abstract: Background Patent foramen ovale (PFO), a common congenital atrial septal abnormality, can induce intracardiac right-to-left shunt (RLS) and is a potential risk factor for migraine. Currently, there is no unified consensus regarding the therapeutic efficacy and specific molecular mechanisms of PFO closure in the treatment of migraine. Methods A single-center retrospective cohort study was conducted, enrolling 107 patients with PFO and migraine, of whom 58 underwent transcatheter PFO closure (observation group) and 49 received standard medical therapy (control group). All patients underwent cardiac imaging and contrast-enhanced transthoracic echocardiography before treatment, with follow-up assessments of headache episodes and scale scores at 1, 3, 6, and 12 months post-treatment. Simultaneously, peripheral arterial blood samples were collected from 5 PFO patients before and after surgery and from 5 healthy controls for plasma proteomic analysis, and changes in arterial partial pressure of oxygen and oxygen saturation were monitored. Results The improvements in Visual Analogue Scale (VAS), Headache Impact Test (HIT-6), Migraine Disability Assessment (MIDAS), and Migraine-Specific Quality of Life Questionnaire (MSQ v2.1) scores at each follow-up time point were greater in the observation group than in the control group (all P < 0.05). At the 12-month follow-up, the overall treatment effective rate was 94.83% in the observation group, higher than 73.47% in the control group, with a statistically intergroup difference ( P = 0.003). Stratified efficacy analysis revealed a higher proportion of markedly effective cases and a lower proportion of ineffective cases in the observation group, with statistically differences in the distribution of markedly effective and ineffective cases between groups ( P < 0.05). Postoperative arterial partial pressure of oxygen and oxygen saturation were markedly improved compared with preoperative levels. Proteomic analysis suggested that the expression levels of inflammation-oxidative stress-related proteins, represented by myeloperoxidase (MPO), lysozyme C (LYZ), and heat shock protein 60 (HSPD1), were downregulated after surgery, and these changes appeared to be associated with the alleviation of hypoxia after elimination of intracardiac shunting. Conclusions PFO closure improved migraine symptoms in appropriately selected patients and was associated with downregulation of inflammation-oxidative stress proteins (MPO, LYZ, HSPD1). These findings provide preliminary molecular insights warranting further validation in larger cohorts.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2026.1928840