Background RLS is considered as a risk factor for migraine, but the correlation between the RLS and migraine remains controversial. To investigate the prevalence and Right-to left shunt (RLS) grade of PFO in patients with migraine (including migraine with aura and without) and assess the association between PFO and migraine. Methods Synchronous test of contrast transthoracic echocardiography (c-TTE) and contrast transcranial Doppler ultrasonography (c-TCD) was conducted in 251 patients with migraine, including 61 migraine with aura (MA) and 189 migraine without aura (MO) and 275 healthy adults. Among these patients, 25 patients with migraine and 14 healthy adults were evaluated by transesophageal echocardiography (TEE). Results (1). The prevalence of permanent RLS, total RLS and large RLS in migraine was significantly higher compared with controls (P = 0.042, < 0.001 and 0.001, respectively). (2). Compared with controls, the positive rate of total RLS and large RLS in MO was increased (P = 0.004 and 0.022 respectively), the positive rate of permanent RLS, total RLS and large RLS in MA was also increased (P < 0.001 for each of the comparisons). The positive rate of permanent RLS and large RLS in MA was significantly higher than in MO (P = 0.004 and 0.011 respectively). (3) The presence of large-size PFO (≥ 2.0 mm) of migraine was higher than that of controls (P = 0.048). Conclusion PFO is associated with increased migraine (especially with aura), when the PFO is permanent RLS, large RLS and large-size PFO (≥ 2.0 mm).

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