Migraine Headache and the Patent Foramen Ovale

Abstract

What are the indications for closure of a patent foramen ovale (PFO) in an adult? Very few questions in the field of cardiology are as controversial. Disagreement exists about definitive indications for PFO closure under various circumstances. Approximately 25% of all adults have patency of the foramen ovale. This translates to 60 million people in the United States who have this finding. It is estimated that there are 280 000 cryptogenic strokes per year.1,2 Patients with cryptogenic stroke have a higher prevalence of PFO than age- and sex-matched controls.3,4 Nevertheless, without pathological evidence, definitive proof of the linkage is hard to come by. Statistical associations can be suggestive or even rather convincing, but for the vast majority of patients, absolute evidence is lacking. Catheter interventions for such patients are usually performed at low risk, but are even small risks justified when cause and effect remains unproven? There is extensive literature that attempts to answer this question, but controversy remains. Article see p 1406 Patients who have had a cryptogenic stroke and a PFO are often treated with chronic anticoagulation therapy, and the risk of recurrent events appears to be reduced.5 Currently, the labeled indication for PFO device closure is recurrent stroke in patients who had an event despite treatment, or are not candidates for anticoagulation. Nevertheless, a considerable number of interventional and general cardiologists are convinced that device closure in the cardiac catheterization laboratory is …