Evaluation of the Frequency of Patent Foramen Ovale in Children with Migraine: A Prospective Case-Control Study

Objective: To evaluate the frequency of patent foramen ovale (PFO) in children with migraine and to assess its association with clinical characteristics, heart rate, and electroencephalography (EEG) findings. This prospective study included children aged 5-18 years diagnosed with migraine according to the International Classification of Headache Disorders criteria, and a control group of age-and sex-matched healthy children. Transthoracic echocardiography was performed to determine the presence of PFO. Electroencephalography was conducted in the migraine group. Clinical and laboratory data were compared between migraine patients with and without PFO. PFO was detected in 15 of 71 children with migraine (21.1%) compared with 2 of 71 control subjects (2.8%), demonstrating a significantly higher prevalence in the migraine group (p<0.003). The migraine patients with PFO had a significantly higher mean resting heart rate than those without PFO (p<0.001), although all values were within age-appropriate physiological limits. EEG evaluation was performed in 59 migraine patients and revealed epileptiform abnormalities in 9 patients (15.3%). The frequency of pathological EEG findings did not differ significantly between migraine patients with and without PFO (p<0.261). None of the patients had clinical epilepsy, and cranial MRI findings were normal in all cases. Children with migraine exhibit a higher prevalence of patent foramen ovale compared with healthy peers. Notably, migraine patients with PFO showed higher resting heart rates than those without PFO, suggesting potential involvement of autonomic regulation. The lack of association between PFO and EEG abnormalities indicates that the migraine–PFO relationship in childhood is most likely indirect and multifactorial. These findings indicate the need for larger studies on neurocardiac interactions in patients with migraine and PFO.