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To the Editor:
I read with interest the findings by Anzola et al.1 that patent foramen ovale (PFO) was twice as frequent in their patients with migraine with aura (48%) as in those with migraine without aura (23%) and that spontaneous right-to-left shunt across the PFO was four times as frequent in patients with migraine with aura (7%) as in patients with migraine without aura (1.8%). It would be not only interesting but also important to know if the attacks of migraine in the rest of the patients with aura, i.e., 46 patients, correlated with such Valsalva-provoking activities as straining during defecation or micturition, asthmatic attacks, whistle-blowing, or sexual intercourse.
Patent foramen ovale is a frequent finding in normal subjects: 27.3% from an autopsy study2 and 10% from an echocardiographic study.3 Normally there is no right-to-left shunt across the PFO because the flap is closed due to higher pressure in the left …
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