Transcatheter closure of patent foramen ovale for migraine prophylaxis: hope or hype?

igraine has generally been conceptualized as a primary isorder of the brainstem that mediates sensory input and eural influences on cranial vessels. It is estimated that ,500,000 patients in the U.S. have at least one migraine per eek, with a lifetime prevalence of 18%. Migraine is a risk actor for cryptogenic stroke, particularly in young patients ithout atherosclerosis risk factors. In fact, the prevalence of ubclinical lesions in the cerebellum in patients with miraine with aura, particularly women, is up to 15-fold higher han controls (1). However, the underlying pathophysiology f migraine is not well understood, and new paradigms in nderstanding the underlying etiology and optimizing therpy are being explored.