What causes migraine? It might have something to do with not your head but your heart! DR ROHIT KHURANA, a consultant cardiologist at The Harley Street Heart & Vascular Centre, discusses how a tiny hole in the heart called the PFO (patent foramen ovale) could play a role in your migraine symptoms.
More than just a headache, migraine is a debilitating neurological condition affecting millions worldwide. Migraine symptoms are characterised by the likes of intense pain, nausea and sensitivity to light and sound. The condition can significantly impact the quality of life. So what exactly causes migraine? While various triggers such as stress, diet and hormonal changes are well-documented, research has validated an important relationship between migraine and a structural defect – a hole in the heart known as a patent foramen ovale (PFO).
What causes migraine – understanding migraine symptoms and a hole in the heart called PFO
The foramen ovale is a small hole between the upper chambers of the heart. It naturally closes shortly after birth in most people. However, in approximately 25 percent of the population, this hole remains open, or “patent”. A PFO can allow unfiltered blood clots and chemicals to bypass the lungs and reach the brain’s microcirculation, potentially triggering migraine in susceptible individuals. An important role of the lungs is to filter impurities, and this is bypassed. This link is particularly strong in patients experiencing migraine symptoms or episodes preceded by an aura. This is a type of headache accompanied by visual disturbances or other sensory symptoms.
Treatment options for PFO
For patients suffering from frequent, severe migraine symptoms unresponsive to traditional strategies, or those needing multiple medications, PFO closure has emerged as a promising intervention. This minimally invasive procedure involves sealing the PFO with a specially designed device delivered via a catheter through a vein in the leg. The method has shown a reduction in the frequency and severity of headaches in some individuals, particularly those with migraine associated with aura.
Clinical studies support the efficacy of PFO closure. Trials have reported that a significant proportion of patients experienced a notable decrease in the frequency of migraine episodes after the procedure. While not a universal solution, PFO closure offers hope to those whose symptoms resist other therapies.
When to seek help from a cardiologist
It’s crucial to consult with a specialist for proper evaluation. Diagnostic tests such as contrast echocardiography or a bubble study can confirm the presence of a PFO. If a link between migraine and PFO is established, a tailored treatment plan, including the possibility of closure, may be recommended.
If you’re among the many sufferers seeking an understanding of what causes migraine and relief from migraine symptoms, exploring the connection to PFO could unlock a path to better health. Speak with both your primary care physician and cardiologist about this innovative approach to determine whether you would benefit from further testing.
The Harley Street Heart and Vascular Centre (Gleneagles Hospital)
#02-38/41 Annexe Block, 6A Napier Road
6472 3703 | harleystreet.sg/heart/doctors/dr-rohit-khurana
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This article first appeared in the January 2025 edition of Expat Living. You can purchase the latest issue or subscribe so you never miss a copy!
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