Subclinical Brain Lesions in Magnetic Resonance Imaging are a Potential Indicator of Patent Foramen Ovale Related Migraines in Younger Patients.

Background: The causal relationship between migraines and patent foramen ovale (PFO) remains controversial, and a major unresolved question is how to define migraines attributable to PFO. Thus, this study aimed to determine if brain lesions could be a potential indicator of PFO-related migraines.

Methods: Consecutive migraine patients from 2017 to 2019 who underwent transthoracic echocardiography or transcranial Doppler examination with an agitated saline contrast injection were assessed for right-to-left shunts. We then presented diffusion-weighted imaging (DWI) in brain magnetic resonance imaging and its association with PFO in the included patients.

Results: A total of 424 patients with a mean age of 44.39 ± 12.06 years were included in this retrospective study. Among them, 244 patients (57.5%) had PFO, and 246 patients (58%) had subclinical brain lesions-the brain lesions presented as single or multiple scattered lesions. No association was observed between PFO prevalence and brain lesions in the total cohort (odds ratio (OR) 0.499); however, a significant association was observed in patients aged less than 46 years (OR, 3.614 in the group aged <34 years, 95% confidence interval (CI) 1.128-11.580, and 3.132 in the group of 34 years ≤ age < 46 years, 95% CI 1.334-7.350, respectively). Lesions in patients with PFO observed using DWI came more from the anterior or multiple than the posterior vascular territory (p = 0.033). DWI lesion numbers, location, and right-to-left shunt amounts did not affect the association between DWI-observed lesions and PFO.

Conclusions: This study demonstrated that subclinical brain lesions are associated with PFO and may be used as a potential predictor of PFO-related migraines in patients aged less than 46 years. This may help identify candidate patients for PFO closure in future clinical decisions.