PFO and headaches

[woohaa]

Hello,

I saw something on TV that peaked my interest, I think it was that Mystery Diagnosis show...It was about a recent correlation between PFO's and headaches.  

How much do you know about this?  

As a 29 year old man, I have been a daily 24/7 headache sufferer for 3 years now and my headache is very refractory to any sort of treatment.

Recently I did start having palpitations and tachycardia, which lead to a peliminary diagnosis of SVT, but I was wondering, would my resting trans-thoracic echocardiogram 100% have seen a PFO?   Or is TEE required to be sure?  What percentages of PFO is missed on standard echo?

Any and all info on this is appreciated.

[Karki]

I'm not a physician, just a patient.  I'm in my (eek) mid-50's now, and just last year was diagnosed with a PFO.  I've since had it repaired via a clam shell device called Amplatzer, and have been AMAZINGLY headache free ever since.  Prior, I had headaches every day, with many migraines tossed in for effect.

I, too, was diagnosed with SVT, and a condition called POTS (where your blood flow and heart beats vary depending on your body's position - sitting up, laying down, etc.)  

I had seen 7 different cardiologist over a period of 8 years, most of them specializing in arrhythmia's and ablations.  One night, I had what felt to me like a stroke - fast, painless, but half by face and body felt numb / tingly.  I could function fine, but it FELT wrong.  Went to the ER, where they thought it had been a heart attack, as my EEG was abnormal, showing not enough oxygen.  They put me in ICU, and then did an emergency angioplasty, which showed NOTHING - no blockage, no buildup, no calcium, zip.  They eventually just sent me home.  I had an MRI, and ECHO, several EEGs, the angioplasty; all the heart tests they could think of.

I still felt my body wasn't right, as half was still tingly / numb.  I went to my internist, who ordered a TEE.  There it was - a giant PFO!  Yes, my internist found it, but not one of my cardiologists!  So, I had the implant (30 minutes plus 12 hours laying flat in bed) and have felt AWESOME ever since.  NO headaches; NO migraines, MUCH MORE energy.  NO heart palpitations (although I do take Inderal for my tachycardia)... best thing I've EVER done.

So in my experience, yes, a PFO can be missed, even when the doctors are in the arteries looking around; the just didn't look in the veins!

(Oh - the final story:  I apparently had a blood clot that went THROUGH the PFO, and then went to my brain, which is what caused the stroke -- yep, a stroke.  My stroke wasn't muscular, but sensory -- if you looked at me, you'd never know; my smile is still symmetrical, my arm and leg strenths are equal on both sides -- but my left side is still tingly and numb.  I get some sensations back now and then, which are the nerves rebuilding, but it just feel like a battery is buzzing. )

GOOD LUCK to you!  Hope this helps.

[Douglas Bogart, MD]

There is an association of PFO and migraines.  If the transthoracic echo is done with agitated saline and with a Valsalva (bearing down like to have a bowel movement) the sensitivity is good.  There are ongoing trials to see if closure of the PFO will relieve the headaches.