A migraine is more than a headache. It seizes the whole body. There is nausea, fatigue, and general malaise. Migraines can have many causes. These may include a congenital heart malformation called patent foramen ovule (PFO) that affects about 25 percent of the population.
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People with PFO are born with a small hole between the chambers of the heart. Most people who have PFO experience no symptoms. But they may be at higher risk of stroke. They also appear more likely to have migraines – especially migraines that are preceded by optical or physical sensations known as an “aura”.
PFO can be closed by relatively simple surgical or endovascular procedures. A certain logic, supported by some studies, suggests that PFO closure might be a good way reduce migraine symptoms and the risk of strokes. But PFO closure is controversial. Richard A. Krasuski, MD, director of the Adult Congenital Heart Disease Center at Cleveland Clinic, has demonstrated that closure performed on PFO accidentally discovered during surgery for another condition, more than doubled a patient’s initial risk for stroke.
Stewart Tepper, MD, of the Center for Headache & Pain in the Cleveland Clinic Neurological Institute, has published studies of the complex relationship between PFO and migraine. “Evidence for PFO closure resulting in improvement of migraine symptoms is often anecdotal, uncontrolled, or case controlled,” he notes. ”
A randomized controlled trail, called MIST, produced no evidence that PFO closure could improve migraine symptoms. Another large trial to assess PFO closure for stroke, called CLOSURE-1, failed to meet its end point and was also negative. There are some FDA-approved PFO closure studies now enrolling patients in the United States, but Cleveland Clinic is not participating in these studies for migraine currently. These trials have had a very hard time getting patients to participate because of the requirement for half of the participants to undergo cardiac catheterization without treatment. There are still 2 trials underway nationally on PFO closure for strokes.”
At this time, neither Dr. Krasuski or Dr. Tepper would recommend PFO closure to treat migraine symptoms or stroke, outside of a clinical trial.