Heart defect, migraines linked

Deseret News (Salt Lake City), Dec 25, 2006 by Lois M. Collins Deseret Morning News

Randy J. Harris has had several strokes linked to a malfunctioning flap valve between the upper chambers of his heart.

But when doctors did an outpatient catheter repair of the valve recently, the Kaysville man noticed something else that has been widely reported but not scientifically proven: His infrequent but migraine-strength headaches went away.

LDS Hospital is part of a national, multi-center clinical study to see if it can prove what many neurology, pain management and heart specialists have come to believe: For some people, treating a migraine headache requires a heart repair.

The heart problem is called patent formen ovale and some experts believe as many as half of all migraines may be related to PFO, which is a well-known risk factor for stroke. Other researchers have already noted a link between strokes and migraines.

Besides stroke, PFO can cause decompression illness in scuba divers who do everything right but still get sick. It's linked to sleep apnea.

The World Health Organization lists migraines as one of the top 10 disabling illnesses. In the United States, they cost as much as $20 billion a year just in lost productivity and affect nearly 30 million Americans. Researchers believe as many as 100,000 Utahns have had disabling migraines. A small study in England found that of patients who had PFO closure, more than half were cured of migraines and another 15 percent or so had the severity and number of migraines reduced.

But while PFOs are routinely fixed to prevent strokes, severe migraine is not a diagnosis for which the procedure is currently FDA- approved, or for which insurance companies will pay, said Dr. Sherman G. Sorensen, director of the cath lab at LDS Hospital and principal investigator for the hospital in the migraine-PFO study. If the study finds what many believe it will, it should help convince the FDA, insurance companies and even headache doctors that implanting a device to fix the PFO not only makes people feel better, but saves money in the long run.

Everyone starts life with a PFO -- a flap in the wall between the upper chambers of the heart through which moms provide oxygen to babies in utero. In about one-fourth of children, though, it doesn't close like it's supposed to. That's not automatically cause for treatment, which depends on the size of the PFO. The relationship to strokes comes because as blood flows between chambers (which isn't supposed to happen), the PFO may allow blood clots to skip being filtered in the lungs and pass into the brain.

Requirements for the clinical trial are stringent. A patient has to have a certain number of migraines, but not too many, and have failed two medication treatments designed to prevent the migraines. Half the participants get a closure device called the Amplatzer PFO Occluder and the other half don't. Neither the neurologist who provides after-care nor the patient will know whether the device was implanted or not, Sorensen said, so they can scientifically see if closing the PFO impacts migraines.

The flap is closed by deploying a pair of discs by catheter through the groin and up into the heart. One goes on each side of the wall dividing the heart's upper chambers, pinching the PFO closed. Then the catheter is withdrawn and the heart's normal cells will grow over the implant in a few months, becoming part of that dividing wall. PFO closure typically takes about 35 minutes that way, Sorensen said.

To help screen potential participants, the researchers are using a Web site called utahmigraine.com, which has a small quiz. All those who take it will be called back, whether they qualify or not, Sorensen said. In all, LDS Hospital hopes to enroll about 45 patients. (Half of them will receive the device.)

The plan is to follow the study participants about a year after the device is placed (or isn't).

More information on PFOs is available at Sorensen's Web site, sorensenmd.com.

E-mail: lois@desnews.com