The relationship between the PFO and migraine headaches remains poorly understood.  We know that 40 - 50% of patients who have "aura" preceding their migraines have a PFO.  We also have observed that in some patients, when the PFO is closed, that headaches are dramatically improved, or resolve completely.  This can occur in patients with and without migraine aura. Unfortunately closing the PFO only changes the migraine symptoms in some patients.

 

Until now, we have not had a good understanding of how to choose the patients who might potentially benefit from such a procedure.  Without this knowledge, it is difficult to recommend an invasive heart procedure for a patient who might not benefit.

 

Our recent publication, (Spencer et al.  Cephalalgia 2014. 34:933-937 ), showed that we may also be able to treat headaches in patients with PFO, using a specific blood thinner called clopidogrel. This medication, and others like it, inhibit the platelets in the blood from forming blood clots and from releasing chemicals which cause constriction (narrowing) of blood vessels.  It is unknown why this drug works to improve migraine symptoms, but may indicate a relationship between migraines and platelet by-products which may cross the PFO, from the right heart, and reach the brain.

 

In our small series, most of the patients who responded to the medical treatment with clopidogrel also had a beneficial response to the closure procedure.  Thus, for some patients with migraine and PFO, this class of medication may not only be an excellent headache medication but may also help to predict whether a patient will respond to the closure procedure.