Impact of Percutaneous Patent Foramen Ovale Closure on Migraine Course

Markus Schwerzmann; Bernhard Meier

Disclosures

Interv Cardiol. 2013;5(2):177-187. 

In This Article

Abstract and Introduction

Abstract

Migraine is a neurological disorder characterized by an increased individual susceptibility to respond to certain triggers by a propagating wave of neuronal depolarization that culminates in typical migraine headaches. Patients with a patent foramen ovale or any kind of right-to-left shunt are more likely to have migraine; and patients with migraine with aura are more likely to have a patent foramen ovale than patients without migraine. Nonrandomized reports of patent foramen ovale closure in divers, in patients with paradoxical embolism and in migraine patients with ischemic brain lesions have shown an impressive reduction in migraine headaches during follow-up. To date, the only double-blind, randomized controlled trial with a sham procedure in the control arm failed to show any benefit, probably owing to inadequate patient selection and maybe because of a high residual shunt rate. Two other randomized trials continue to enroll patients with migraine with aura and drug-refractory headaches and their results are awaited.

Introduction

In 1942, a distinguished Havard professor of physiology published a paper entitled 'voodoo death'.[1] The paper reported anecdotal experiences of death from fright and was an early example of the 'brain–heart connection'. The term 'brain–heart connection' includes the heart's effects on the brain (e.g., cardiac sources of embolic stroke) and the brain's effects on the heart (e.g., ECG abnormalities in patients with subarachnoid hemorrhage).[2] The first thoughts of neurologists in response to preliminary reports suggesting an interaction of intracardiac shunts with migraine may have included attributes such as voodoo and unwittingly but correctly pointed to a brain–heart connection.[3–5]

This article summarizes the current knowledge regarding migraine pathophysiology and the data regarding the impact of patent foramen ovale (PFO) closure on migraine. We continue to have a limited understanding of the mechanisms of how a PFO and migraine may be inter-related, and the concepts regarding migraine pathophysiology in the setting of a PFO that we discussed recently[6] have neither been proven nor refuted yet.

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