A Hole in the Heart and a Pain in the Head

woman with headache (holding head)

By Dr. Peter Abaci

Migraine headaches are one of our biggest and most challenging pain problems to treat. About 11% of the American adult population suffers from migraines and almost 17% will experience a severe headache in any given three month time period. Migraines are the fifth leading cause of emergency room visits, and middle-aged females seem to be at the highest risk. A family history of migraines also seems to be another strong risk factor. Migraine headaches also seem to be a significant source for lost work days, with an annual cost of $24 billion in medical expenses and lost productivity.

Migraines with aura occur when feelings or symptoms are experienced prior to the onset of the headache. Migraines with aura account for almost 20% of all migraines and symptoms may include blind spots, flashing lights, and visual hallucinations. While it is still unclear what causes the aura, it is believed to be due to imbalances that take play within the brain leading to an over-reaction in the immune response which may cause vasodilation and headaches. 

One of the interesting discoveries made on migraines with aura, in particular, came about by chance. That has to do with its link with another condition known as patent foramen ovale. In utero, the foramen ovale connects right and left atria of the heart. After birth, this opening will fuse closed, but in 25% of cases the opening will close but not fuse, which allows blood or blood particles to get across. This residual patency can become a risk factor for clots bypassing the lungs and going to the brain and causing a stroke. Under these circumstances, heart surgery will often be done to close a patent foramen ovale to prevent recurrent strokes, and more recently, this is when doctors and patients started to notice that those who had this surgery and also had migraines with aura started to see resolutions in their headaches. These case reports lead to a series of studies which seemed to show that patent foramen ovales are found in 40-60% of patients with migraines with aura.

Why the connection between the two conditions? That still seems to be unclear, and we can’t yet say that a patent foramen ovale directly contributes to migraines. Subsequent research is now being done to figure out if repairing a patent foramen ovale can reliably relieve migraines with aura. So far, there have been some positive findings, but perhaps nothing conclusive yet where it has become a recommended treatment approach. This connection may help further our understanding of headaches. For example, this could be a case of a strong genetic predisposition to certain painful conditions, or it may be a case of identifying specific chemical headache triggers traveling to the brain through patent foramen ovales. These discoveries will hopefully improve our ability to better treat migraines.


Image courtesy of stockimages at FreeDigitalPhotos.net

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