PFO and Migraine - "Hole in the Heart" and Migraine?

by Teri Robert, Lead Expert

One of the biggest topics of discussion amongst Migraineurs today is that of PFO, "the hole in the heart" that may contribute to Migraines. Migraineurs are asking their doctors to test them to see if they have this condition. Many of those who do want to have the hole repaired -- immediately. However, questions remain and the closure procedure is not yet being performed on the basis of Migraine disease because it has not yet been proven effective. Trials are underway to determine the efficacy of PFO closure for Migraine disease.

What Is PFO
PFO stands for patent foramen ovale. A PFO is a hole in the wall (septum) that divides the right and left atrium (chambers) of the heart. We all have a PFO during fetal development, but it usually closes before birth. The right side of the heart receives blood and pumps it to the lungs for oxygenation. The blood then goes through the left side of the heart to be pumped to the brain and other organs. A PFO can allow blood that hasn't been oxygenated by the lungs to get into the left side of the heart, thus being pumped to the brain and other organs. If this happens, the body doesn't get enough oxygen. It's also possible that blood clots can pass through the PFO and cause a stroke. PFO is diagnosed with a TEE (transesophageal echocardiogram), which is performed by passing an ultrasound probe down the esophagus, near the heart to get better results than the traditional echocardiogram, which is performed with a standard ultrasound wand outside the chest.

PFO and Migraine
Research has shown a higher prevalence of PFO among Migraineurs than among people without Migraine.3 Small observational and case-control studies indicate that patients with cryptogenic (of unknown origin) stroke have a higher incidence of patent foramen ovale.4 It's still under investigation whether patent foramen ovale closure prevents recurrent strokes. It is thought to be possible that blood without enough oxygen may trigger a Migraine when it reaches the brain. In the April, 2004, issue of Neurology, two groups of researchers from Belgium (Post, et al) and Switzerland (Schwerzmann, et al) studied whether percutaneous closure (closing the PFO by a technique that does not require a major surgical procedure) would lead to fewer Migraines.

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