Doctors once debated whether the cause of migraines for some people might be a hole in the heart. Yes, a hole in the heart…a condition in which a space in the hearts of newborns—that is actually supposed to be there to help blood circulate in the fetal heart—doesn’t close up shortly after birth as it is supposed to. Current research says that, yes, a hole in the heart is associated with migraine and with stroke, too. But will closing the hole cure the migraine? The answers are not so cut-and-dried, but here’s what you should know. First, though, I need to explain the stroke connection.
NOT A RARE THING
The hole is called a patent foramen ovale (PFO). It’s not rare, either. About 25% of the people on planet Earth have it—maybe even you. There usually are no symptoms, and a PFO won’t necessarily cause health problems. It can, however, cause blood that is moving through the upper right chamber (atrium) of the heart, destined for the lungs (which are designed to filter out blood clots), to pass into the left chamber if too much pressure builds in the chest from ordinary body functions, such as sneezing, coughing or straining during a bowel movement. Doctors have theorized that this misdirected blood flow might be the cause of some cryptogenic (that is, unexplained and unpredicted) strokes because about 40% to 50% of people younger than 55 and 20% of people 55 or older who have cryptogenic strokes turn out to have PFOs.
Having a second cryptogenic stroke, therefore, has become a reason why a patient, especially a younger patient, would be given an imaging test, called transesophageal echocardiography, to find out whether a PFO is present. If a PFO is found, the patient’s doctor would recommend a medical procedure to close it. Trouble is, although thousands of stroke patients have had PFO closures, evidence is increasingly showing that closure doesn’t necessarily prevent another stroke from happening. And so research into why so many people with cryptogenic stroke have PFOs continues.
PFOs AND MIGRAINES
But the focus on PFO closure in stroke patients eventually revealed a link between PFO and migraines. Physicians were finding that migraine in some stroke patients who had been migraineurs decreased or completely went away after PFO closure. But results from a recent study by British researchers put the association between migraine and PFO and the value of closing a PFO for migraine into question.
These researchers examined dozens of scientific articles and found that results varied so widely from one study to the next that it wasn’t possible to confidently say that closing a PFO could or would improve or cure migraine. For example, an analysis of 18 studies that specifically looked at the effect of PFO closure on migraine found that migraine was cured in a whopping 83% of migraineurs in one study, only 14% in another study and everything in between in several other studies.
Results from the only randomized controlled trial—the gold standard of medical research study designs—that has been done on the topic did not offer encouraging news. In this study, 74 patients were randomly assigned to have PFO closure and 73 received a sham operation. The results? No difference in migraine improvement between the two groups was seen.
So what’s the bottom line if you have chronic migraines and haven’t had much success with migraine relief drugs or other approaches? If your pain is frequent, long-lasting or very intense, it may seem to you that anything with a chance of helping is worth trying. A doctor who isn’t up on the most recent research might even suggest that you get a transesophageal echocardiogram to find out if you have a PFO. But which patients with PFOs and migraine—and even whether patients with PFOs and migraine—can benefit from PFO closure is not completely clear. Until additional rigorous studies confirm that closing PFOs helps migraines—and for which patients—you may want to dedicate yourself to the much better-proved strategies for for pain relief and migraine management.