| What is a Migraine Headache? |
Not all headaches are migraine headache and it is sometimes difficult to decide.
Classic migraine headache is a primary headache (not due to stroke or tumor) which is usually one sided, throbbing, severe, and usually comes with nausea, vomiting, sensitivity to light or sound, or motion sensitivity.
Migraine usually runs in families and is thought to have a hereditary tendency. |
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| What are Migraine Aura? |
15 -20% of migraine sufferers have associated symptoms called AURA.
Aura are usually visual (shimmering lines, flashes etc) but stroke-like symptoms (loss of sensation or vision, weakness, inability to speak) may also occur and are considered aura.
However, it may be difficult to distinguish migraine aura and stroke or TIA (mini-strokes) which then cause secondary migraine headache.
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Do I Have Migraine?
Are My Headaches Migraine Headaches? |
Many patients have more than one type of headache.
The International Headache Society (IHS) has developed rules which are accepted by headache specialists to aid in telling who has migraine:
-- Headache lasts 4-72 hours
-- The patient must have 2 or more of these symptoms:
- one-sided headache
- pulsating or throbbing
- moderate to severe headache
- made worse by moving
-- The patient must have 1 ( or more) during the headache:
- nausea or vomiting
- sensitivity to light or sound |
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| What Are The Effects of Migraine? |
Migraine is not a functional disorder of stress, anxiety or depression.
Migraine is disabling for many patients in spite of medical therapy. Migraine results in the loss of billions of dollars in work productivity. More importantly, migraine takes a tremendous toll on patient and family quality of life.
Refractory migraine is a significant cause of depression.
Migraine headache ( particularly with aura) is a very real risk for stroke. |
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| Patent Foramen Ovale (PFO) and Migraine Headache |
See our Septal Defects page
50% of migraine patients have a PFO and most of these have large shunts (see our TCD page)
The theory is that substances in the blood bypass the lungs and trigger migraine. Alternatively, small clots may pass through the PFO and trigger migraines without causing stroke.
Scuba divers often have migraines after diving and the chance is much higher in divers with large PFO performing deep dives where bubbles come out of the blood and travel to the brain through the PFO (rather than stopping in the lungs). Our first understanding of migraine improvement with PFO closure came from divers with migraine & decompression illness. |
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| Relief of Migraine After PFO Closure |
Wilmshurst in England first reported the improvement of migraine headache (84%) and the complete relief of migraine (45%) in divers who had PFO closure to prevent decompression illness.
The graph above shows the results of migraine relief with PFO closure in our NVI Program for patients treated because of stroke caused by the PFO.
There are now over 15 studies of catheter PFO closure for stroke prevention where the secondary benefit of migraine relief occurred in very similar numbers: Usually 80% said they were better and ½ of those said they had complete resolution of migraine symptoms. |
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| Migraine and Stroke |
Migraine is a significant risk for stroke. Migraine medicines used properly do not cause stroke or heart attack.
Patients having a stroke due to a PFO are much more likely to have a second stroke if they also have migraine.
MRI (brain imaging) in migraine patients shows that the risk of stroke is increased 15 times for women with migraine with aura and 1 attack per month.
Smaller brain lesions (WMH= white matter hyper-intensities or so-called “spots”) are 3 fold increased in migraine patients and are related to neurologic disability in the future. |
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| Is Catheter PFO Closure and Accepted Treatment for Migraine Headache? |
We require neurology specialist consultation in all of our PFO closure patients
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We recommend that patients with severe or refractory migraine see a Headache Specialist.
PFO closure is not yet approved as a migraine treatment. More scientific proof is needed before this procedure can be used as a routine migraine treatment. Participation in the PREMIUM research study will help to prove the benefit of PFO closure and help many in the future. |
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| Premium |
PREMIUM is a double blind, randomized research study to evaluate the benefit of PFO closure (using the Amplatzer® PFO device) on patients with migraine headache who have failed 2 medications.
½ of patients will receive PFO closure and ½ will not. All patients will undergo evaluation including intra-cardiac echocardiography.
This research is critical to the approval and acceptance of this treatment by the FDA, headache specialists, and insurance companies. |
