Investigating the Patent Foramen Ovale–Migraine Link in Southern Saudi Arabia

Objective: Migraine is a highly disabling neurological condition, and increasing attention has focused on a possible connection with patent foramen ovale (PFO). Methods: This single-center observational study enrolled 45 individuals from January to April 2024: 30 migraine patients with PFO (Group 1) and 15 migraine patients without PFO serving as controls (Group 2). All subjects underwent transthoracic echocardiography and completed standardized instruments including the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6), Migraine Symptom Severity Scale (MSSS), Allodynia Symptom Checklist (ASC-12), Visual Aura Rating Scale (VARS), and Migraine Treatment Optimization Questionnaire (mTOQ-6). Results: The participant's mean age was 37.3 ± 9 years. More than half experienced migraine with aura, a proportion notably greater among those with PFO. A positive family history, suboptimal response to therapy, and positional exacerbation were significantly associated with the PFO group. Fibrinogen concentrations and several migraine-related scores including MIDAS, HIT-6, MSSS, ASC-12, and mTOQ-6 differed significantly between groups. Conclusion: Migraine linked to PFO are more likely to have an aura, a stronger family patterns, worsening symptoms based on position, and overall, greater disability and increased severity of symptoms. These findings support an association between PFO and migraine characteristics and may have implications for clinical management.