PFO Closure for Migraine: An Update

12-14 years ago, there was a lot of discussion about “PFO closure” for migraine.

PFO stands for patent foramen ovale, a hole in the heart between the right and left chambers. A PFO is a common developmental condition, affecting about 1 in 4 people. But you may never know you have it.

patent foramen ovaleSurgery can be done to close the PFO, for example if someone has low blood oxygen levels that may be caused by the defect. But years ago, patients who had the surgery for various reasons began to report that their migraine attacks had also subsided.

And so began the investigations and the trials. The well known MIST trials, originally planned as a series of four trials, were cancelled before the second one was completed. The results were not encouraging.

More studies have been done recently, and results continue to be mixed at best.

So why is PFO closure still being discussed? First, because some patients do experience a reduction in migraine symptoms after PFO closure. Second, it’s clear that migraine and PFO are somehow linked – PFO patients are much more likely to have migraine, and migraine patients are more likely to have PFO.

But a relationship does not mean that fixing one problem will fix the other, as trials have shown.

But there is more. For example, particles that move from one side of the heart to the other (through a shunt) may lead to migraine – not to mention the relationship between stroke, PFO and migraine. These particles in the blood may trigger a cortical spreading depression, a key part of the migraine chain-reaction.

In short, there are good reasons to think that PFO may actually increase migraine attacks.

So why doesn’t everyone with migraine just have the surgery? There are actually good reasons. And this has been one of the downfalls of the trials – patients simply don’t want to have heart surgery – even if it’s fairly simple surgery.

Though the surgery is generally safe, there are risks. In a report published earlier this month, PFO and Migraine: Is There a Role for Closure?, the authors noted that “several potentially life-threatening procedure-related adverse events occurred in the clinical trials”. There are also concerns that the surgery may lead to other health problems down the road.

Researchers remain intrigued by the possible connection between PFO closure and migraine. Although trials have been disappointing, it’s still worth trying to understand the connection, which may lead to other types of treatment. And it could be that we can find a certain type of migraine patient who will benefit from PFO closure, even if those are a small percentage of migraineurs.

But in the mean time, the poor chance of success, and risk of other health issues, and availability of many better treatments, continue to leave PFO closure in the area of research and not in the area of recommended treatments.

As the authors of the above say, although some patients who have the surgery for other reasons may see a decrease in migraine symptoms (either due to the closure or other reasons?), they “recommend against offering PFO closure as a preventive treatment for migraine”.

See also Closing PFO closure for migraine?

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5 comments… add one
  • Terri Apr 16, 2017

    I had a PFO closure back in 2007 at Shawnee Mission Medical Center as a live web cast for OR Live. It had no effect on my migraines. I would still recommend that anyone with this type of ASD have the closure done though since it also reduces the risk of stroke!

  • M Simmons May 9, 2017

    There have been an inordinate amount of PFO closures done by one doctor in the state of Utah, that are now being investigated for being unnecessary. I had one of these devices placed and the doctor and Gore company were misleading about the content of the device; after having nothing but health problems since it being placed, we recently learned I am allergic after discovering the true composition of the device. I have had it removed and my symptoms are diminishing. I was not experiencing migraines prior to having the PFO closure, but suffered from frequent headaches and migraines after the device was placed. There is plenty of information about this online, including medical research on the benefits and drawbacks of PFO closure–I encourage everyone to do their research and self-advocate!

    • Erind Pepi Aug 30, 2017

      Hi there,

      How many months after the implant did you remove the device? Was it removed the same way it was placed or did you have to go through traditional surgery?
      I had the implant about 3 months ago in Stockholm with the GORE device. Some weeks after the surgery I started getting extra heart beats, that many as I felt like I was running out of breath. This was solved with beta-blocker medicine for the heart. It’s been now a month and a half I am having extreme headaches and what I believe migraines. At times my left hand is weak, at other times my right hand is weak. It is keeping me from work and and paracetamol and codeine are not helping either.

      Would appreciate an answer.

      Thanks!
      Erind

  • Marcin Jan 5, 2018

    Sorry for being pedantic but the PFO is not between chambers (or ventricles as shown in the picture above) but between atria. It might seem an insignificant detail but it makes real difference.
    Best,
    Marcin

    • James Jan 9, 2018

      Thanks for the comment, Marcin! You’re right, my language and the picture are both imprecise. I referred to the atria as “chambers”, just as a general term. The four chambers would be two atria and two ventricles.

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