Patent Foramen Ovale (PFO) and migraines are common conditions. A PFO is a heart finding, while migraines are a neurological disorder characterized by severe headaches. A potential connection between these two conditions has been a subject of scientific interest. This article will explore the current understanding of this association.
Understanding PFO and Migraine
A Patent Foramen Ovale is a small, flap-like opening between the heart’s two upper chambers, the right and left atria. This opening is a normal part of fetal circulation, allowing blood to bypass the lungs before birth. While it typically closes shortly after birth, it remains open, or “patent,” in approximately 20% to 30% of adults. Most people with a PFO experience no symptoms, as it generally does not impact their health or lifespan.
Migraines are intense, debilitating headaches, often described as throbbing pain lasting from four to 72 hours. They are frequently accompanied by symptoms like nausea, vomiting, and heightened sensitivity to light, sounds, or smells. Migraine with aura involves temporary neurological symptoms that precede or accompany the headache. These auras commonly manifest as visual disturbances (e.g., flashing lights, blind spots) but can also include sensory changes or speech difficulties. Migraine without aura is more common, occurring without these preceding neurological signs.
Exploring the PFO-Migraine Link
Studies have observed a higher prevalence of PFOs in individuals with migraines, particularly those with aura, compared to the general population. While this association is noted, the precise causal relationship remains a topic of ongoing research and is not yet fully understood or universally accepted.
One leading theory suggests a PFO may allow small blood clots or vasoactive substances, like serotonin, to bypass the lungs’ filtering system. Normally, the lungs filter these particles or chemicals from the bloodstream. With a PFO, these substances could travel directly from the right side of the heart to the left, and then to the brain. Once in the brain’s arterial circulation, they might trigger a migraine attack by affecting brain activity or blood vessels.
Another hypothesis involves cortical spreading depression, a mechanism underlying migraine aura. Substances or small emboli bypassing the pulmonary filter through a PFO could influence or initiate this wave of altered brain activity. This might explain why the association appears stronger for migraines with aura, as these events involve neurological changes. Despite these theories, definitive proof of these mechanisms consistently causing migraines in individuals with PFOs is still being sought.
Diagnosis and Treatment Considerations
A Patent Foramen Ovale is often discovered incidentally during diagnostic tests for other conditions, such as stroke evaluations or cardiac concerns. The primary diagnostic method is echocardiography, an ultrasound visualizing the heart. A “bubble study” is frequently used: saline with tiny bubbles is injected into a vein. If a PFO is present, bubbles are observed crossing from the right to the left side of the heart, confirming the opening. This can be performed using transthoracic echocardiography (probe on chest) or transesophageal echocardiography (probe down esophagus for clearer view).
For most individuals with migraines and a PFO, closure is not a routinely recommended treatment. Current scientific evidence does not definitively show widespread effectiveness for migraine relief, and the procedure carries risks. PFO closure typically involves minimally invasive cardiac catheterization, implanting a device to seal the opening.
PFO closure is primarily indicated for other medical conditions, such as certain strokes where a paradoxical embolism through the PFO is suspected. In rare, carefully selected cases of severe, debilitating migraines unresponsive to other treatments, where a specialist suspects a PFO-migraine link, closure might be considered after thorough evaluation of benefits versus risks. However, standard migraine management, including medications and lifestyle adjustments, remains the primary approach for most migraine sufferers, regardless of a PFO.