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Closing Hole in Heart to Treat Migraine

By now you’ve probably heard about studies linking migraine with a hole in one’s heart for some people. It was much ballyhooed in the media in the first six month of the year, but generally with little information to explain what it was, who might have it and how it was tied to migraine. I’ve been asked about this topic recently and realized that I’ve neglected it here. So I’m changing that.

pfoThe hole, called a patent foramen ovale (or, more commonly, PFO), is an opening between the upper chambers of one’s heart. The hole is present in fetuses to allow blood to pass from one side to the other. (The graphic is from Cleveland Clinic’s PFO page, click on it to enlarge it.)

In most people, the gap closes at or after birth. For an estimated 25% of the US population, it doesn’t close completely and the PFO forms. This remaining tunnel functions as a valve. Normally the valve is shut, but sometimes remains open, sending blood that’s supposed to go to the lungs off to the brain and other parts of the body.

This isn’t an issue for most people with PFOs, but there’s always an exception. Some patients who had PFOs closed for a reason unrelated to migraine have reported that their migraines were gone or didn’t happen as often after the surgery. Thus spurring research into whether surgery to close PFOs is an effective treatment for migraineurs.

The evidence so far indicates that migraineurs who have auras may have more success with PFO closures than those without auras. Some articles I’ve read limit the population to people with auras, but others include all migraineurs.

The first migraine-specific study of PFO closure with a large population, called MIST, is underway in the UK. Results are expected to be announced next spring. There are two upcoming studies in the US. The one listed on NIH’s clinical trials site is called Paradigm II. Recruiting hasn’t begun, but eligibility details are available. Another, ESCAPE, has received conditional approval from the FDA.

The best site I’ve found for easy, straight-forward information is on MIST’s website. Although the study is no longer recruiting participants, the site explains the components of the problem and gives evidence supporting a connection between PFO and migraine. An overview of all this information is also available in PDF. An article in Science News has another terrific introduction.

Fellow blogger Teri Robert of Putting Our Heads Together has also blogged about PFO recently. Her take on it includes more detail than this one so make sure to check it out.

3 Responses to Closing Hole in Heart to Treat Migraine

  1. James says:

    Thanks for blogging about this. The thing that has bothered me most about the coverage of this research is that it’s frequently called a possible “cure for migraine”, as if it’s the long awaited blanket cure for everyone with migraine.

    It may (or may not) help a whole bunch of people (I hope it does!). But it’s unlikely to help everyone, and “cure” is certainly the wrong word.

    Thanks for giving clear information without the hype!

  2. santhosh says:

    hi,
    i suffer from migran for almost six years,i very curious about the cure of migran, sometimes i feel not to live, but i control my self, please give me some suggestion on this, it will be very kindfull

    *********
    There are many options for treatment, so please hang in there. I’m not sure where to start with the information. I’ll round some things up and e-mail them to you.

    K

  3. Pam says:

    Hi,
    I’ve had migraines since puberty, I’m now 58, recently I started suffering from daily morning migraines for the past 3 months, my neurologist seems to be of little help. I’ve taken Imitrex since it first came out 10 years. With the daily migraines I take the Imitrex everyday and my neurologist wants me to stop taking the Imitrext so she has put me on some other medications and they have not worked, I’ve been on Tramadol until it hurt my stomach, and Clonazepam in the p.m. but it didn’t stop the morning headaches it only made me lethargic most of the day. The the last thing she tried to get me to take was Cymbalta, but when I heard the warning on TV that it wasn’t to be taken with migraine medicines and found a warning on a website about taking it with Imitrex I decided that I was too scared to take it. Oh and she also sent me to physical therapy 3 days a week, which I loved the massages but I still had the heaadaches so I discontinued. So here I sit with my headache…I’m hoping that maybe you have some information that you can email me. Or the name of a good neurologist in Phoenix, AZ. Sometimes I feel like the the person in the email above mine and I just do not want to live, it’s very frustrating. Thank you for any help. ppk347@aol.com

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