Heart Defect in Children with Migraine with Aura
In a small study of children with migraine (109 children six and over) the presence or absence of a heart defect known as patent foramen ovale was studied. Thirty-five per cent of the children in the study had migraine with aura. About half of the migraine with aura kids had the PFO heart defect, as compared to 27% of the children with migraine without aura.
What is PFO?
PFO (patent foramen ovale) is a form of heart defect. The foramen ovale is a hole in the heart wall that has a purpose when a baby is in the womb. It allows blood to bypass the lungs, because babies do not breathe with their lungs until they are born, and get their oxygen from the mother’s blood. Once born, this opening usually closes naturally in infants. Sometimes when it persists past infancy, a PFO will still close spontaneously, but this generally occurs before age six.
In the adult migraine population, it has been found that about 25% of all migraine patients have PFO. Trials of PFO closure in adults have been inconclusive. Several smaller, single center trials have shown high response rates to closure of PFO. The only multi-center, double-blind trial of PFO closure failed to show positive results, but was potentially flawed in terms of patient selection and other technical issues.
In this study, the severity of migraine was not associated with the presence or absence of PFO. The study was limited by the inability to place IV lines in control subjects and do a direct comparison of data from the study population and the control population. Because of the small sample size in this study and because of the other controversies associated with testing and treatment of PFO, authorities in the field have recommended further study before recommending PFO closure in children.