PFO

9 April 2011

In Children, the PFO Solution Studied

Research continues on the option of PFO closure for people with migraine. As you may remember, studies in the past so far seem to show that we need to know more about which type of patients this may help. But this time, researched focused on children with migraine rekindles the debate.

PFO, or patent foramen ovale, has been the focus of a surgery that closes a common "hole in the heart". The question is – could closing this hole lead to relief from migraine?

Dr. Rachel McCandless led the team from the Primary Children’s Medical Center and the University of Utah to study the question. 109 children between the ages of 6 and 18 enrolled in the study. The researchers took two-dimensional echocardiograms of each child’s heart, looking for the PFO defect.

Of the children who had migraine without aura, about 25% of children had PFO – that reflects the % of the general population.

However, for children with migraine with aura, the % jumped to 50% – that’s double the general population. That also reflects the original numbers given early on in PFO-Migraine research.

Most likely, as with adult migraine patients, we need to learn more about the type of PFO that children have, and we need to correlate this with other health factors, before we can really know who to start treating. But the research is not dead – there seems to be a connection here. We just need more information to understand what it is.

For more on recent research into PFO and migraine, don’t miss Should we give up on the PFO Closure Solution? and from ScienceDaily Study Suggests a Relationship Between Migraine Headaches in Children and a Common Heart Defect.

23 February 2010

Should we give up on the PFO Closure Solution?

James News, Treatments 0

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.

31 January 2008

MIST II trial cancelled

James News 2

The MIST I and II trials have been the centre of a lot of controversy. You might not remember the name, but you may remember the treatment. Some people have a patent foramen ovale (PFO), which is an opening in the heart. A simple operation is able to close this opening, and some people have found a reduction in migraine attacks after the procedure.

The idea was to conduct multiple trials and collect data in MIST I, II, III and IV. MIST II was more ambitious than MIST I, a larger study with a longer follow-up time.

But a number of problems came out after MIST I. First, the results were less than encouraging. Then in October a co-investigator of the trial, Dr Peter Wilmshurst, expressed concerns about how the data was managed and reported. Those running the trial then claimed Dr Wilmshurst was in fact not a co-investigator, but was dropped due to protocol violations. Then other experts called for an independent review, but it was claimed patients would need to give their consent, and so on and so on….

In the end, the NMT Medical (who was running the trial) closed it. It looks like the bottom line was money – the trial required a lot of patient screening, and it was going to drag on too long to be "worth it".

This was an important study, and it’s too bad it died. There was a lot of media attention, making it sound like this was a cure-all for migraine, which is unlikely. It would be nice to get the confusion cleared up.

The good news is that this is not the end of PFO treatment for migraine. Other trials are on and continuing and we will hear more about it in the future. Meanwhile, NMT continues its studies but will be focusing on PFO closure and stroke. Read more in NMT Medical to shut down patent foramen ovale/migraine MIST II trial.

21 March 2006

Hole in heart – disappointing trial

James Discoveries & Stats, Treatments 0

The most recent trial to see if a surgical procedure could help migraine sufferers was…not quite the success that was hoped for. Sort of.

The fact is that the hole in the heart closure, called the PFO closure procedure, so far hasn’t turned out to be the migraine cure-all. The surgery did seem to decrease the "migraine load" on patients by 37% (migraine load refers to number of hours with headaches multiplied by number of headaches). That’s great – except that other preventative treatments can do just as well or better. So the question is, who’s going to want to go under the knife when they can get help without the surgery?

There are some good points, though. First, maybe this will help someone that hasn’t been helped by anything else. Second, more trials are needed. There is something here that is helping us better understand where migraine comes from. It may be that future trials will give more clues and better results. It may be that certain types of migraine are affected more than others.

For more on the trial, check out the official NMT Medical’s MIST Study press release [link no longer available].

2 September 2005

Visual PFO treatment…

James Resources 0

You’ve read here several times about PFO and it’s relation to migraine. Check out the article from HeadWay, "Mixed Blood and Migraines" for more on how this common heart defect may be related to migraine.

If you really want to know more about the defect and the operation needed to solve the problem, check out the MIST website. They have diagrams, explanations of words, and even a video animation, which is very helpful. Here’s the page with the video and diagrams of PFO. They have other materials around their site to help you understand what all the excitement is about. Who knows? Maybe this will be the key to fighting off your migraine…

I’d be interested if anyone reading this has personal experience with PFO and migraine. Feel free to comment!