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Amanda Jekowsky , American College of
Cardiology, 202-375-6645, ajekowsk@acc.org
February
16, 2009
Closure of Patent Foramen Ovale May
Benefit Migraine Sufferers
Reducing the frequency and severity of disabling migraines
is crucial for quality of life. A new study, published in
the February 2009 issue of JACC: Cardiovascular Interventions,
finds significant improvement of migraine following catheter-based
closure of patent foramen ovale (PFO)—a slight opening
in the wall between the right and left atria.
These findings confirm those of previous observational studies,
which consistently show that when a PFO is closed—whether
it’s following a stroke or decompression illness—migraine
also tends to improve in the majority of cases (approximately
75 percent). However, the present study was the first to enroll
patients with severe migraine, a large PFO and no history
of stroke or transient ischemic attacks, but with silent brain
lesions on magnetic resonance imaging.
“The study suggests closure of a large PFO may improve
migraine in patients with subclinical brain lesions, as well
as those with prior stroke,” says Carlo Vigna, M.D.,
of Casa Sollievo della Sofferenza IRCCS Hospital, San Giovanni
Rotondo, Italy. “In the past, the beneficial effect
on migraine was occasionally seen after PFO closure was performed
for other reasons, for example, unexplained stroke. Conversely,
the recently published MIST trial did not show significant
improvement of symptoms in ‘pure migraneurs’ in
the absence of symptomatic or subclinical cerebral ischemia.
As compared with these two extremes, we enrolled patients
with an intermediate subset of characteristics.”
Patients were divided into either the closure (n=53) or control
(n=29) group based on their consent to undergo percutaneous
PFO closure, and prospectively examined for 6 months. Compared
with the medically treated control group, closure of a PFO
resulted in greater numbers of patients who had cessation
of migraine attacks, cessation of disabling attacks and over
50 percent reduction in migraine attacks.
While this may be good news for certain migraine sufferers,
researchers say a larger randomized trial focusing on this
patient population is needed. In addition, the relationship
between PFO and migraine must be further examined and understood.
“We don’t really know what’s going on.
A stroke could be caused if a blood clot passes across a PFO
and travels to the brain, but with migraine we don’t
yet know what the trigger substance is that crosses the shunt,”
says Dr. Peter Wilmshurst, Royal Shrewsbury Hospital, United
Kingdom. “Not everyone with migraine has a PFO, and
not everyone with a PFO has migraine; there are other causes
that we don’t yet understand.”
Background: It is widely accepted that migraine
is associated with higher rates of stroke. Research also suggests
that people with migraine also have a higher prevalence of
right-to-left shunts on contrast echocardiograms, which are,
by and large, due to PFO—something each of us has while
in the womb to divert blood away from the lungs. However,
for one in four people, a hole remains after birth.
The American College of Cardiology is leading the way to
optimal cardiovascular care and disease prevention. The College
is a 36,000-member nonprofit medical society and bestows the
credential Fellow of the American College of Cardiology upon
physicians who meet its stringent qualifications. The College
is a leader in the formulation of health policy, standards
and guidelines, and is a staunch supporter of cardiovascular
research. The ACC provides professional education and operates
national registries for the measurement and improvement of
quality care. More information about the association is available
online at www.acc.org .
The American College of Cardiology (ACC) provides these news
reports of clinical studies published in the Journal of the
American College of Cardiology as a service to physicians,
the media, the public and other interested parties. However,
statements or opinions expressed in these reports reflect
the view of the author(s) and do not represent official policy
of the ACC unless stated so.
###
The American College of Cardiology is leading the way to optimal
cardiovascular care and disease prevention. The College is
a 36,000-member nonprofit medical society and bestows the
credential Fellow of the American College of Cardiology upon
physicians who meet its stringent qualifications. The College
is a leader in the formulation of health policy, standards
and guidelines, and is a staunch supporter of cardiovascular
research. The ACC provides professional education and operates
national registries for the measurement and improvement of
quality care. More information about the association is available
online at www.acc.org .
The American College of Cardiology (ACC) provides these news
reports of clinical studies published in the Journal of
the American College of Cardiology as a service to physicians,
the media, the public and other interested parties. However,
statements or opinions expressed in these reports reflect
the view of the author(s) and do not represent official policy
of the ACC unless stated so.
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