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. 2023 Jan 27;23(1):44.
doi: 10.1186/s12883-023-03059-z.

Normobaric oxygen may attenuate the headache in patients with patent foramen povale and migraine

Mengqi Wang  1   2   3 , Duo Lan  1   2   3 , Chaitu Dandu  4 , Yuchuan Ding  4 , Xunming Ji  1   2   3 , Ran Meng  5   6   7
Affiliations

Normobaric oxygen may attenuate the headache in patients with patent foramen povale and migraine

Mengqi Wang et al. BMC Neurol. .

Abstract

Background and purposes: There has been both great interest in and skepticism about the strategies for headache inhibition in patients with patent foramen ovale and migraines (PFO-migraine). Furthermore, many questions remain about the fundamental pathophysiology of PFO-migraines. Herein, the inhibiting effect of normobaric oxygenation (NBO) on PFO-migraine was analyzed.

Methods: This real-world self-control study consecutively enrolled patients during the ictal phase of migraines who had patent foramen ovale (PFO) confirmed by Trans esophageal Ultrasound(TEE). After comparing the baseline arterial oxygen partial pressure (PaO2) in their blood gas with that of healthy volunteers, all the patients with PFO-migraine underwent treatment with NBO (8 L/min. for 1 h/q8h) inhalation through a mask. Their clinical symptoms, blood gas, and electroencephalograph (EEG) prior to and post-NBO were compared.

Results: A total of 39 cases with PFO-migraine (in which 36% of participants only had a small-aperture of PFO) and 20 non-PFO volunteers entered the final analysis. Baseline blood gas analysis results showed that the PaO2 in patients with PFO-migraine were noticeably lower than PaO2 levels in non-PFO volunteers. After all patients with PFO-migraines underwent NBO treatment, 29(74.4%) of them demonstrated dramatic headache attenuation and a remarkable increase in their arterial PaO2 levels after one time treatment of NBO inhalation (p < 0.01). The arterial PaO2 levels in these patients gradually went down during the following 4 h after treatment. 5 patients finished their EEG scans prior to and post-NBO, and 4(80%) were found to have more abnormal slow waves in their baseline EEG maps. In the follow up EEG maps post-NBO treatment for these same 4 patients, the abnormal slow waves disappeared remarkably.

Conclusions: Patients with PFO-migraine may derive benefit from NBO treatment. PFOs result in arterial hypoxemia due to mixing of venous blood, which ultimately results in brain hypoxia and migraines. This series of events may be the key pathologic link explaining how PFOs lead to migraines. NBO use may attenuate the headaches from migraines by correcting the hypoxemia.

Keywords: Blood gas analysis; Hyoxemia; Migraine; Normobaric oxygenation; Patent foramen ovale.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study. PFO: patent forman ovale; NBO: normobaric oxygenation; EEG: electroencephalo-graph
Fig. 2
Fig. 2
The variation of PaO2 during before NBO and 4 h after NBO are showed, there is significant increase after NBO, and the value of PaO2 fall down gradually during the 4 h after NBO
Fig. 3
Fig. 3
Difference of brain activity between before and after NBO. A slow waves are found on the temporal cortex of patients with migraine before undergoing NBO. B the brain activity was normal after undergoing NBO
Fig. 4
Fig. 4
Hypothesis of how hypoxemia causes migraine and slow waves on EEG
See this image and copyright information in PMC

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