So, you’ve been told that you have migraine disease! Some people are relieved to finally have a diagnosis while others have sudden fear and anxiety. On top of that, your health care provider shares with you that you have migraine with aura. This brings a whole new set of questions and issues. Then, as you’re discussing your migraine with aura, you are informed that there’s an associated heart condition. Now you’re in panic mode.
We know that 40 million people in the U.S. have migraine. Of the 40 million, 25 – 30% have migraine with aura. It is estimated that aura occurs in 25 – 30% of people with migraine, causing disturbances in vision, sensation, and speech. Aura typically begins 1 hour before or during a migraine attack and lasts for less than 60 minutes. So what is this associated heart condition and what do we know about it?
Patent Foramen Ovale – PFO
The foramen ovale is a flap in the atrial septum, the wall between the left and right upper chambers of the heart. The foramen ovale is supposed to close at birth, yet in about 25% of the general population, it remains open. Several studies have found that the incidence of PFO among patients who have migraine with aura is 46.3 – 88% as compared to 16.2 – 34.9% in migraine patients without aura.
Chronic migraine is also more prevalent in those with PFO – 66%, as compared to the general population and patients with episodic migraine.
The Link Between Migraine and PFO
The direct relationship between migraine and PFO is unknown as yet. There are several theories:
- Some chemicals and hormones (ie-serotonin) bypass the lungs and move through the blood brain barrier causing a migraine attack.
- Tiny clots, too small to cause a stroke, may reach the brain triggering the migraine directly or chemicals released on the right side of the heart may cross over and be responsible for a migraine attack.
- Non-oxygenated blood from the right side of the heart can enter the left side and mix with oxygenated blood, triggering brain depression resulting in a migraine attack.
- Genetic factors may lead to both diseases without one causing the other.
Treatment for PFO
PFO treatment includes medicinal and surgical options. Medicinal treatment includes anti platelet or anticoagulant medications. These will help with the prevention of blood clots. Surgical closure remains controversial. Management needs to be multidisciplinary with a cardiologist and a headache specialist.
Social support is a vital part of your treatment plan. In addition to your support system, tapping into resources for migraine support,mainly support groups, will offer you comfort and for you to know that you are not alone. Having comrade with fellow people with migraine, who can relate to your fears, anxieties and issues will decrease your’s and lead to feel empowered and that you are your own best advocate.
We need more research on PFO and migraine to identify the cause and determine the treatment. We’re not ready to “close” the book.