Can plugging a hole in the heart end headache agony?
Why? Researchers suspect that some substance that migraine sufferers are sensitive to--perhaps a hormone or minute particles of debris--is taking the PFO detour around the lungs and going directly to the brain, where it disturbs blood vessels and triggers a migraine. Normally the lungs filter such things out.
The evidence has mounted to a point where one device manufacturer, Boston-based NMT Medical, started the trial in England this January in which some migraine patients will get PFO closure but other volunteers, unknowingly, will get a fake treatment. The results should indicate whether the operation actually does stop migraines or--if the sham treatment group also improves--if the procedure is simply producing an illusory effect. It will be next year before results are known. Another company, AGA Medical Corp. of Minneapolis, has requested permission from the Food and Drug Administration to undertake a similar study in the United States.
Desperate patients. If the treatment clears the scientific bar, insurance companies might cover it for migraine. So it's not surprising that mesh manufacturers are pursuing it. "It would be a huge market," says cardiologist Sotirios Tsimikas of the University of California-San Diego. "But we have to be careful not to oversell this until we have better data."
Demand for the procedure is already racing ahead of the evidence. When NMT sought fewer than 200 volunteers for its British trial, thousands of interested--and desperate--people overwhelmed its website and jammed phone lines with inquiries. One of them was Jacquelyn Compton, 56, a Williamsburg, Mass., resident, who suffers migraines on as many as 23 days per month. Compton doesn't even know if she has a PFO, and if she gets into a trial also won't know whether she gets the mesh plug or a sham procedure.
None of that deters her. She plans to get tested for the defect--usually a small probe is pushed down the throat to image heart structure with ultrasound--as soon as possible. "If I have the PFO," she says, "I'll get the repair by hook or by crook. It's just too alluring to think of being free of this."
Med for the head
Heart repair isn't the only migraine help available. Medicines can stop a growing migraine or even prevent one from starting.
Easing attacks. Triptans are often the drugs of choice for severe migraines. These medications can alleviate or even stop oncoming headaches, but they need to be taken early, while symptoms are still mild.
Prevention. Topamax was developed to help seizures. Taken daily, it can stop migraines before they begin. Drugs called beta blockers do this too, and Topamax may not work any better, but it can have an appealing side effect--weight loss. (And an unappealing one--forgetfulness.)