PFO and migraine

Case: 38-year-old female is admitted to ICU third time with a severe headache. All extensive neurological diagnostic workup turned out to be negative again alike last 2 previous admissions. Neurology service recommended closure of benign Patent Foramen Ovale (PFO) as a treatment for migraine.



Answer: There are some anecdotal reports that closure of PFO may help in decreasing the intensity of migraines. There is no strong evidence in this regard (multiple references below show mixed results). Said that, in patients who require frequent hospital admissions, and if symptoms become life-debilitating, this may be of consideration.  Risks and benefits should be discussed with the patient in detail before pursuing this invasive procedure. The etiology behind this correlation is not fully understood.

#neurology
#cardiology


References:

1. Dowson A, Mullen MJ, Peatfield R, et al. Migraine Intervention With STARFlex Technology (MIST) trial: a prospective, multicenter, double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache. Circulation 2008; 117:1397. 

2. Mattle HP, Evers S, Hildick-Smith D, et al. Percutaneous closure of patent foramen ovale in migraine with aura, a randomized controlled trial. Eur Heart J 2016; 37:2029. 

3. Schwedt TJ, Demaerschalk BM, Dodick DW. Patent foramen ovale and migraine: a quantitative systematic review. Cephalalgia 2008; 28:531. 

4. Schwerzmann M, Wiher S, Nedeltchev K, et al. Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks. Neurology 2004; 62:1399. 

5. Post MC, Thijs V, Herroelen L, Budts WI. Closure of a patent foramen ovale is associated with a decrease in prevalence of migraine. Neurology 2004; 62:1439. 

6. Reisman M, Christofferson RD, Jesurum J, et al. Migraine headache relief after transcatheter closure of patent foramen ovale. J Am Coll Cardiol 2005; 45:493. 

7.  Anzola GP, Frisoni GB, Morandi E, et al. Shunt-associated migraine responds favorably to atrial septal repair: a case-control study. Stroke 2006; 37:430. 

8. Yankovsky AE, Kuritzky A. Transformation into daily migraine with aura following transcutaneous atrial septal defect closure. Headache 2003; 43:496.