Should we give up on the PFO Closure Solution?

At one time, the PFO closure seemed like one of the most hopeful treatments for migraine.  With a simple surgery, could your migraine attacks disappear?

PFO stands for patent foramen ovale, and the surgery closes a common "hole in the heart".  When some patients getting the surgery reported that their migraine attacks had gone away, research was started to see if this treatment might hold the answer for a lot of migraineurs.  (read more about what we said about PFO surgery in this edition of HeadWay back in 2003)

But the results of the research was unimpressive.  Trials were cancelled.  And patients started to look elsewhere.

But is this line of research dead?  Should we be taking a closer look?

Researchers in the Department of Cardiology, University of Palermo (Italy) have decided to take a closer look, both at stroke patients and migraineurs who have PFO.  The question is, what is their condition like?  Not all PFO is the same – what if migraineurs with a certain type of PFO would benefit from surgery?

What the researchers did is compare migraineurs with patients with ischaemic stroke.  Then they categorized the group by a couple of different factors – "embryonic recesses" and the severity and size of the PFO.

The results they found didn’t point obviously to which patients would benefit most from surgery, though the obvious answer would be those with the most severe PFO.  However, it at least demonstrated the fact that both stroke and migraine patients varied quite a bit in a) whether or not they even had PFO (about 2/3 or migraineurs didn’t) and what type of PFO they had.

So the next step?  Find out which patients benefit more from the simple surgery.  What if, for example, 75% of patients with large PFO and migraine would find relief from surgery, while the others would not?  It would be a big reason to avoid surgery in patients without severe PFO, and a big reason to give it a try in patients with severe PFO.

We’ll be watching for further research to tell us if PFO closure may still be promising for a large group of migraineurs.

Read about the study:  The PFO anatomy evaluation as possible tool to stratify the associated risks and the benefits arising from the closure.

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