May 13th, 2010
All this talk about migraines and PFO closure is giving me a headache!
Richard A. Lange, MD, MBA
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?
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.