Closing a Heart Hole May Help Migraines

Can closing a hole in the heart be an effective treatment
for migraines?

New research suggests that it may for migraine sufferers with a common heart
abnormality known as a patent foramen ovale (PFO).

But a researcher who has studied the issue for almost a decade tells WebMD
that the jury is still out on the treatment.

In the new study, patients with PFOs who had a minimally invasive
catheter-based procedure to close the small hole in their heart had
significantly fewer disabling migraines than patients with PFOs who did not
have the procedure.

Migraines and PFO Closure

As many as one in four people have a PFO abnormality, but most never know
it.

Prior to birth, everyone has the small opening, which exists to divert blood
away from undeveloped lungs. Normally, the hole closes after birth, but in some
people the closure is not complete.

While not everyone with PFOs has migraines and not everyone with migraines
has PFOs, studies show that migraine sufferers are far more likely to have the
heart abnormality than people without migraines.

PFO researcher Peter Wilmshurst, MB, of the UK's Royal Shrewsbury Hospital,
tells WebMD that about half of patients with a specific type of migraine known
as migraine with aura have large PFOs or similar openings in their hearts
compared to about 5% of the population at large.

Wilmshurst did not participate in the new study, but he was involved in an
earlier study that examined PFO closure as a treatment for migraines. Published
last year, that study, known as the MIST trial, found no benefit for the
treatment.

The new study included 82 migraine patients who had large PFOs and no
history of strokes. All the patients also had a type of brain lesion that is
commonly seen in brain scans of patients with migraines.

Fifty-three of the patients had the PFO closure procedure and 29 did
not.

At six months follow-up, the PFO closure patients showed significant
improvements in both the frequency and severity of their migraine
headaches.

In all, 53% of patients in the PFO closure group reported a disappearance of
disabling headaches, compared to 7% of the patients who did not have the
closure procedure; 87% in the closure group reported a more than 50% reduction
in total headaches, compared to 21% of the patients in the comparison
group.

The study appears in the Feb. 24 issue of the Journal of the American
College of Cardiology.

"Only patients in the closure group reported a significant reduction of
migraine severity, which is crucial for quality of life," study researcher
Carlo Vigna, MD, and colleagues write. "In contrast, the number of
disabling attacks did not change or increased in 41% of controls."

Why Findings May Vary

In an accompanying editorial, Wilmshurst suggests that the placebo effect
may explain why the findings in the latest trial are so different from those in
MIST trial.

The 147 MIST participants had no idea which treatment they were getting, but
the 82 patients in the latest study chose the treatment they received.

"It is possible that in patients with migraine the placebo effect from
an operative intervention might be much greater than the magnitude of placebo
effects with drug treatments," he writes.

But Wilmshurst tells WebMD that this doesn't explain why early studies
showed PFO closure to be an effective treatment for migraines. That's because
patients in these early trials had the procedure for other reasons and had no
expectations that their headaches would improve.

Several devices used for PFO closure are being marketed in the U.S., and
Wilmshurst says PFO closure is commonly performed in patients with migraines
even though it is considered experimental and the devices have not been
approved for the treatment of migraines by the FDA.

"Some people would sk if we should really be using this treatment,
since we can't say for sure that it works." he says. "I don't really
know the answer to that question."

By Salynn Boyles
Reviewed by Louise Chang
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