Altamura C, et al. - Because the causal link between patent foramen ovale (PFO) and migraine with aura (MA) is controversial, researchers ascertained if clinical features of the attack relate to the presence of right-to-left shunt (RLS) in patients with MA. Data were obtained from the clinical electronic dossiers, clinical characteristics of MA attacks (type, frequency, duration of aura phenomenon, trigger factors, onset age), family history for MA, thrombophilia genotypes, and the response to preventive treatments. Study participants included 111 patients. Binary logistic regression analysis revealed that among characteristics of MA attacks, only onset age was linked to the presence of RLS. The greater RLS severity, the younger was onset age and the presence of atrial septal aneurysms (ASA) was linked to a further reduction in onset age. Family history for MA was related to the presence of RLS. The findings support the hypothesis that although PFO does not affect the frequency of MA attack, it is not merely a bystander in MA physiopathology because RLS, its severity, and the presence of ASA may make a difference in the history of the disease.