Normobaric oxygen may attenuate patent foramen povale-related migraine

Abstract Background: Existing methods on correcting patent foramen ovale (PFO)-mediated migraine (PFO-migraine) are not satisfactory. Herein, the effect of normobaric oxygenation (NBO) on inhibiting PFO-migraine was analyzed. Methods: Patients with PFO confirmed by Transesophageal Ultrasound were enrolled in this real-world self-control study consecutively. Baseline data of arterial oxygen partial pressure (PaO2) from their blood gas was compared to PaO2 values from 20 volunteers without a PFO. Patients with PFO-migraine underwent NBO (8L/min. for 1h/q8h) treatment through a mask. The clinical symptoms, results of blood gas, and electroencephalograph (EEG) pre-and post-NBO were compared. Results: A total of 67 eligible patients entered final analysis, of whom 39 had PFO-migraines. Of those 39 patients with PFO-migraines, a small-aperture PFO accounted for 36%. The PaO2 in patients with PFO-migraine at baseline were lower than that in non-PFO volunteers. After one round of NBO treatment, 74.4% of all PFO-migraine patients demonstrated dramatic headache attenuation, and their arterial PaO2 increased remarkably (p<0.01). This increase in PaO2 was maintained for 4 hours and then gradually declined. EEG data in 12 patients prior to and post-NBO treatment were compared. EEG maps prior to NBO treatment demonstrated significant abnormal slow waves. After NBO treatment, the abnormal slow waves disappeared on EEG maps. Conclusions: PFO-mediated right-to-left shunts induce arterial hypoxemia resulting in brain hypoxia, which may be the pathological link between PFO and migraines. Patients with PFO–migraine may benefit from NBO treatment.