Migraine and PFO

There is an strong association of strokes with migraine and often we see that, following a stroke, the migraine goes away. Some strokes are caused by paradoxical emboli that cross from the venous circulation to the arterial circulation by passing the lung filters, through a patent foramen ovale (PFO).

The PFO is present in all of us, but it uaually closes spontaneously, when we take our first breath. However, in about 20% of the normal, healthy population, the PFO may not close and can potential stay open. In fact, that seems to have been the case with Prime Minister Ariel Sharon of Israel, who initially suffered what appeared to be a TIA and a PFO was discovered.

His doctors anticoagulated him and decided to close the PFO using a percutaneous approach umbrella. However, he suffered a massive cerebral bleed before that could be done. The rest, as we say, is history. We certainly hope he recovers.

Back to our story that some patients with migraine had their their migraine cured with closure of the PFO. This is about to be tested in a large randomised control trial, ESCAPE, to be led by Dr Dodick of Scottsdale, and Dr Sommer of New York.

Can we cure migraine with closure of PFO? The ESCAPE trial will answer that. We await the results.

PFO is also covered here by Kevin MD.