Migraine & PFO

[franny]

Hi there,

I have migraines with visual aura and was sent for an echo which found a "PFO" (hole in the heart).

Is this dangerous? The heart dr said I can decide whether to treat it or not but how am I supposed to?

[drgeroulis]

Hello, thanks for your question. As far as your migraines are concerned, try and have a physician that is good with managing headaches treat you and that your diagnosis of migraine with aura is appropriate http://www.asktheneurologist.com/diagno ... -type.html ; Why was an echo of your heart ordered? What is your health history and presentation that led to them looking at your heart?

To answer your question about PFO closure and migraine headaches, the story as we know it thus far goes as follows: There is a higher number of people who have migraines with an associated PFO than one would have expected. How are the two related? Not enough evidence for cause and effect between the two. Are there people willing to close your PFO because you have a migraine? You bet. Should it be done? We don't know yet. At my institution we are part of a study that randomizes people with PFO and cryptogenic strokes for the closure device. Your situation is somewhat similar in the sense that the data shows migraine with aura (PFO closures) to eliminate headaches. However, and this is a BIG however, the headache relief doesnt seem to be long lasting. In fact we've seen many people after closure to remain headache free for about 3 months out. Then they're back to where they started with migraines. Now, unless your PFO has an associated atrial septal aneurysm, AND you've had a stroke that is cryptogenic (meaning we don't know why you had it happen to you) then there is no good scientific rationale to close a PFO in a migraneur).

If you have migraine with aura, and especially if you're on oral contraceptive pills, it would be wise to refrain from smoking. Strokes happen in young females on birth control pills, with PFO's and who smoke, and in Neurology we see this happen.

[franny]

Thanks for such a comprehensive reply Dr. Gerulis!

You said your clinic is trying-out a new treatment...could you give me more details about this in case it is relevent to me?
Sorry for the delay..i was having some technical issues.
Thanks
F