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ESC Congress 2003: Closing a common heart defect improves migraine
August 31, 2003IMPORTANT: This press release accompanies a poster or oral session given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology
We observed that closing a small common heart defect (patent foramen ovale, PFO) for the prevention of stroke, unexpectedly reduced the occurrence of migraine attacks. The small hole was non-surgically closed by placing an umbrella device through a catheter into the heart defect (transcatheter PFO closure). Given that up to half of patients with migraine with aura - that is migraine with perfidious neurological symptoms preceding the headaches - have been found to live with such a small heart defect, this could be a novel treatment for prevention of migraine.
Migraine headaches afflict about one tenth of the population at some time. Migraine with aura are migraine headaches, preceded by neurological symptoms similar to stroke warning sings like trouble seeing in one eye, trouble speaking, or numbness or weakness in arm or leg. Up to half of all patients with migraine with aura are reported to have an innocent heart defect (a PFO). To further explore the association between PFO and migraine with aura, we investigated the effect of closing the PFO on migraine headaches.
We looked at 215 young adults undergoing transcatheter PFO closure after recovery from stroke. In all patients, the small heart defect was the most likely cause for the stroke. The PFO can serve as shortcut for small blood clots originating form the veins, permitting them to cross into the arterial system and to block a vessel that carries oxygen to the brain. In this situation, for the prevention of an additional stroke the blood must be liquefied with drugs, or the culprit hole must be closed. This can be achieved by transcatheter closure, as we did in our patients. Using a structured questionnaire, we asked our patients to quantify and characterize any kind of headache the year before and after PFO closure. For avoiding any influence on our patients' answers, we did not inform them about a possible relationship between the procedure and migraine headaches.
Nearly a quarter of all patients complained about migraine the year prior to PFO closure. This is twice as much as expected in the general European population. One year after PFO closure, 4 out of 5 patients with migraine reported a marked reduction of their migraine attacks. On average, every second migraine attack was abolished after PFO closure. A quarter of all patients with migraine before PFO closure had no further headache during the year after the intervention. This was observed in patients with migraine with and without aura. In contrast, we did not observe a reduction of headache attacks after transcatheter PFO closure in patients with tension-type or other kind of headaches.
Currently it is not known by which mechanism transcatheter PFO closure reduces migraine attacks. One theory is, that small blood clots passing the PFO might trigger migraine attacks. The clots are probably too small to obstruct large brain vessels and to cause a stroke, but they may lead to small underperfused areas in the brain, sufficient to trigger a migraine attack. According to another theory, a PFO may allow crossing of highly active biological substances into the arterial circulation. These yet unknown substances originating from the veins are usually cleared in the lungs, but may reach the brain via a PFO, and trigger migraine attacks.
Our findings need to be confirmed in well-designed clinical trials. If our observations can be validated, the search for a PFO may become an integral part of the diagnostic work-up of migraine headache. The prospect, that transcatheter PFO closure, a simple cardiac intervention, may reduce migraine attacks or even cure some patients from migraine is encouraging for all those suffering from this disabling condition.
PD Dr. Stephan Windecker
Swiss Cardiovascular Center Bern, Cardiology
University Hospital, 3010 Bern, Switzerland
European Society of Cardiology (ESC)
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