Thursday, October 12, 2006

the scoop on PFO


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If you have heard about the congenital heart defect patent foramen ovale (PFO) and its possible connection to migraine disease, you might be wondering, as I have, whether this defect is something you should be checked for.

PFO is a hole in the heart caused by a failure of the left and right sides of the upper chambers of the heart to join after birth. This hole causes blood to bypass the lungs. There are no known symptoms or risk factors associated with PFO and unless the person has other heart conditions or has experienced stroke, PFO is not treated. However, the notion that closure of PFO may lead to a reduction in migraine attacks has prompted a great deal of talk about whether migraineurs should be checked for this condition. Many people wonder if this fix may be the treatment that will help migraineurs who have not yet been able to achieve effective prevention.

The website Help for Headaches and Migraine has a thorough article discussing the research findings on this condition:

PFO and Migraine: "Hole in the Heart" and Migraine Connection?

While acknowledging that a significant number of people who underwent PFO closure experienced a reduction in migraine attacks, the article points out that these findings are of limited usefulness for migraineurs in two ways:
  • The studies were retrospective (they asked patients for information about their headaches that occurred in the past)
  • The studies included only stroke patients. To obtain more conclusive results, a study is needed to evaluate otherwise healthy Migraineurs and collect data in real time (prospectively).

There was also no control group in these studies, which is essential in determining whether there is a correlation and a routine component of the most well-accepted scientific trials.

The MIST (Migraine Intervention with STARFlex® Technology) clinical trials are currently studying whether there is a correlation between closure of the PFO and the incidence of migraine from a prosecptive perspective. You can learn more about the MIST II trial being conducted in the United States and watch an animation of how PFO may be responsible for migraines at this link: the MIST II Clinical Trial.

For more information about PFO generally and as related to migraine disease, check out these links:
Patent foramen ovale MEDLINEplus
Patent Foramen Ovale (PFO) The Cleveland Clinic
Patent Foramen Ovale and Migraine Bandolier
MIST II Begins: Testing the PFO/Migraine Connection About Headaches and Migraine
MIST Trial Results In: 37% Reduction In Migraine Burden About Headaches and Migraine
The September/October 2006 issue of the National Headache Foundation's Headlines newsletter (available only to subscribers) includes an article on the topic.

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