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Comment on ‘Clopidogrel can be an effective complementary prophylactic for drug-refractory migraine with patent foramen ovale’
  1. Faraidoon Haghdoost1,
  2. Simona Sacco2
  1. 1 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L'Aquila, Italy
  1. Correspondence to Dr Faraidoon Haghdoost, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; faraidoonhaghdoost{at}

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Dear Editor,

Migraine puts a considerable burden on societies with a prevalence of about 14.4% globally.1 It is reported that patent foramen ovale (PFO) is associated with migraine, and its closure may improve migraine outcome. However, there is a dearth of solid and empirical data in this regard to support these claims.2 3 In a recently published paper, Guo et al 4 addressed the preventive effect of clopidogrel in patients with drug-refractory migraine and comorbid PFO. The authors concluded that clopidogrel can be considered an effective complementary drug in patients with refractory migraine and PFO and added to other preventive drugs in these patients. Caution should be exercised when interpreting the findings.

The study by Guo et al 4 was a non-randomized, open-label trial. It is known that three factors, namely the benefit of the treatment, improvement due to the natural history of the disease, and regression to the mean and placebo effect, are associated with treatment efficacy. …

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  • Contributors Both authors contributed equally to the concept of the work, drafting, writing and revising of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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