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Controversies in Interventional Cardiology

Is patent foramen ovale closure indicated for migraine?

Patent Foramen Ovale Closure for Migraine

Mark Reisman, MD and Cindy J. Fuller, PhD

From the Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, Wash.

Correspondence to Mark Reisman, MD, Swedish Heart and Vascular Institute, Swedish Medical Center, 550 17th Ave, Suite 630, Seattle, WA 98122. E-mail mark.reisman@swedish.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Migraine is a heterogeneous primary headache disorder.¹ Migraine prevalence in the general population of the United States is 28 million people (13%) and results in significant costs to the healthcare system.² Aura consists of 1 or more focal neurological symptoms, such as visual, sensory, or speech disturbances,¹ and is present in 30% of migraineurs.³ Cortical spreading depression (CSD), a neuroelectrical phenomenon first described in the rabbit cortex and implicated in the genesis of aura, is characterized by a self-propagating wave of neuronal and glial depolarization followed by hyperpolarization across the cortex.³

Response by Carroll and Carroll on p 468

Patent foramen ovale (PFO) closure resulted in partial or complete relief of migraine symptoms in several retrospective, single-center studies.^4–6 In these studies, PFO closure was performed for secondary stroke prevention⁴ or shunt-related conditions such as decompression illness in scuba divers.⁶ Because no diagnostic or provocative test exists to link PFO to migraine, it is difficult to discern which patients are most likely to respond to elimination of the right-to-left circulatory shunt associated with PFO closure. Migraineurs with aura have a higher prevalence of PFO than migraineurs without aura and nonmigraineurs⁴ and are 4.5 times more likely to have >50% reduction in migraine frequency after PFO closure than migraineurs without aura.⁷

The goals of closing a PFO for migraine headache are to decrease headache burden^4,5,8 and reduce functional disability (ie, inability to perform usual activities or go to work/school because of headache).⁹ Other possible clinical advantages of closure should not be overlooked . . . [Full Text of this Article]