The Medicine Cabinet: Ask the Harvard Experts
Q: I recently had an echocardiogram that showed I have a hole between the two upper chambers in my heart. My doctor thought it might be connected to my headaches. What might that mean for me?
A: Everyone starts off with an oval, flap-like opening (called a foramen ovale) between the right and left upper chambers (atria) of their hearts. This small hole usually closes during infancy. But in about one in four people, it stays open and is known as a patent foramen ovale (PFO).
Most people with the condition have no symptoms and never know they have it unless they have an echocardiogram (echo). Usually the echo is done for some unrelated reason.
Since both headaches and PFOs are very common, it’s not surprising that the two conditions often coexist. However, people with migraine seem to be more likely to have a PFO compared to those with tension or other types of headaches.
To understand why headaches and PFO might be important for you, you first need to determine if you have migraine.
Doctors rely on widely accepted diagnostic criteria to differentiate between migraine headaches and other types of headache. In order to qualify as a migraine, the headache should last between four and 72 hours. It’s typically on one side of the head, but the pain can be more diffuse. It’s often throbbing or pounding, with moderate to severe pain that gets worse with physical activity. To call it migraine, a person must experience at least five attacks that meet most or all of these criteria.
Some people with migraine experience an aura before the headache hits. An aura is typically a visual disturbance such as a pulsing or flashing light, blurriness, or even partial loss of vision. Research has linked this type of migraine headache with having a patent foramen ovale. Up to 60% of people who have migraines accompanied by an aura have a PFO. It’s not clear if the PFO causes the migraines or if people with this type of migraine are, for some other reason, just more likely to have both conditions.
If you do have migraine but no aura, there is no need to repair the PFO. Clinical trials have shown that a surgical fix does not decrease the frequency or intensity of the headaches. However, researchers have found that people who experience migraines with aura are at slightly higher risk for stroke. In these cases, deciding whether to close a PFO can be complicated and may depend upon other potential stroke risks.
(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)