Link Between Migraines and Patent Foramen Ovale

A diagram showing a patent foramen ovale, right.
A diagram showing a patent foramen ovale, right. Enid Hajderi/Stocktrek Images/Getty Images

Some scientific studies have suggested a link between a migraine with aura and a patent foramen ovale or PFO, a relatively common congenital heart defect. With this postulated link, controversy arose within the medical community about whether PFOs should be closed to prevent stroke and migraines—and the overall consensus now leans greatly towards "no."

What Is a Patent Foramen Ovale (PFO)?

The foramen ovale is a hole in the atrial septum—a muscular wall located between the left and right atria, or upper chambers of the heart. This hole forms in utero and closes shortly on its own after birth. In about one-quarter of the population, the hole remains open. With a hole in the septum, non-oxygenated blood from the right side of the heart can enter the left side of the heart and mix with the oxygenated blood. This is called right-to-left shunting of blood. This hole too may allow for tiny clots to travel from the heart to the brain, causing transient ischemic attacks (TIAs) or strokes.

Is There a Link Between PFO and Migraine?

Older studies suggested that people with migraines with aura were more likely to have a PFO and likewise, those with a PFO were more likely to suffer from migraines with auras.

So how is a hole in your heart potentially related to your migraine attacks? Some experts suggested that the mixing of oxygenated and non-oxygenated blood in the heart had something to do with it. Others believed that tiny clots passed from the right side of the heart to the left through the foramen ovale and that these tiny clots traveled to the brain where they triggered migraine attacks. It's important to note that neither of these propositions has been proven—they are vague hypotheses at most. 

This all being said, most headache and migraine experts now argue that these studies were not adequately designed and that there is no good scientific proof that a link between PFO and migraines even exists.

Get A PFO Closed

Research studies to date do not support its benefit. Also, PFO closure is not a minor procedure. There are serious potential side effects including, but not limited to chest pain, abnormal rhythms of the heart, bleeding, and a serious heart condition called cardiac tamponade, which can result in death. 

With that, PFO closure is not a conventional or routine migraine therapy at this time. Going along with this, testing for a PFO with an echocardiogram (ultrasound of the heart chambers) is not a routine practice in those with migraines.

A Word From Verywell

The excitement in the migraine community about closing PFOs for treating migraines (especially those that have not responded to medication), has now died down among most experts. While the procedure may have worked for a few select migraineurs (either in the studies or anecdotally), the scientific evidence is simply not there to back it up. Plus, closure of PFO is not a benign procedure—it's risky, and there are much safer, more reasonable options to pursue for a person's migraine therapy.

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