CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

May 13th, 2010

All this talk about migraines and PFO closure is giving me a headache!

Despite a previous randomized trial showing no improvement in migraine headaches with PFO closure, a new study disputes these findings. In patients with refractory migraines (aura in 80%) and at high risk of right-to-left shunting (all had an atrial septal aneurysm, eustachian valve, large shunt, and coagulation abnormalities), PFO closure significantly improved migraine symptoms.

Howie Herrmann is hesitant to close a PFO for treatment of refractory migraines. I would close the PFO.

Would you recommend PFO closure to your patient with refractory migraine?

Categories: Cardiac Surgery, General, Vascular
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One Response to “All this talk about migraines and PFO closure is giving me a headache!”

  1. Evangelos Polymeropoulos, MD says:
    May 15, 2010 at 4:28 am

    Το effectively randomize such a treatment you need to know how much each patient expects his headaches to resolve after the procedure, whether it is a sham, or a real one. It is obvious that imprinting in such a randomized trial entails not so much age, weight, smoking etc. but expectation. No such imprinting is really feasible at the moment.