Migraine: Have we identified the heart of the matter?

Migraine headache has been associated with an increased frequency of certain cardiac structural abnormalities including patent foramen ovale (PFO) and right-to-left shunts. Improvement or resolution of migrainous symptoms has been reported after procedures performed to close PFO or atrial septal defects. Some authors advocate prospectively evaluating the use of interventional modalities in the treatment of migraine headache. The relevant epidemiology, diagnostic techniques, and treatment options for PFO and associated atrial septal abnormalities are presented initially. A systematic review of the investigations demonstrating an association between these entities and migraine headache is followed by a critical review of the studies noting improvement in migraine symptoms after PFO closure. Reports suggesting the possible utility of percutaneous closure procedures in the treatment of migraine headache are largely retrospective and uncontrolled. Prior to advocating prospective trials to further study the role of invasive procedures in the treatment of migraine, the benign nature of the disorder and the possibility of procedural complications should be carefully considered.