Patent foramen ovale closure – for children?
Patent foramen ovale closure is still being used as a treatment for migraine and other headaches in children. But is it worth the risk?
Patent foramen ovale (PFO) closure is the closing of a common “hole in the heart” that once was hoped to be a great new migraine treatment. So far, however, the surgery has not lived up to the original hype. Trials have failed to put this anywhere close to the top of the list when it comes to migraine treatment.
In spite of the general let-down, the treatment is still being used, even among children.
It has been estimated that one in four people have PFO, but most people have no symptoms at all. But in some people this does seem to contribute to migraine.
Pediatric Neurology recently published a study from the USA on PFO treatment for children in general. Children with both migraine and non-migraine headache usually reported an improvement after the surgery.
So far so good. However, the researchers have some concerns, and rightly so.
First, this study was not designed to see how effective PFO closure was in patients, and so it had a number of shortcomings which we won’t get into here. But there are some things that would be helpful to know. For example, did these patients have other symptoms besides headache or migraine that prompted them to see a cardiologist (in most cases, the procedure was recommended by a cardiologist)? If so, could it be that treating other conditions are actually helping with migraine symptoms?
Researchers are also concerned about long term effects of this surgery (it’s a generally safe surgery, but it’s still surgery), and the cost. If there are less-invasive treatments that work just as well or better, doctors should be cautious about recommending PFO closure.
This study highlights the need for further well-designed studies of PFO closure for migraine and headache. For example, I would like to see further study into type of migraine or headache vs type of PFO.
We’re still getting mixed answers about how helpful it is, and we need to be especially cautious before we recommend it for children.
For more information:
- Should we give up on the PFO Closure Solution?
- In Children, the PFO Solution Studied (a previous study)
- Clinical Practice, Resource Utilization, and Outcomes of Device Closure of Patent Foramen Ovale in Pediatrics. (abstract of the above mentioned study)