PFO Diagnosis

[DocVikingo]

Hi Hemlon,

Does TSandM's discussion of migraine and PFO immediately above not adequately respond to your inquiry?

Regards,

DocVikingo

 

[Hemlon]

I saw the post but I was/am looking for an explantion of why the two may possibly be associated.

 

[bengel]

I saw the post but I was/am looking for an explantion of why the two may possibly be associated.

As someone with Migraines w/Aura and a beginning diver this subject is of great interest to me....

From what I've read they speculate that micro-emobli cross the atrium, goes to the brain and triggers the migraine (a micro ischemia created somewhere in the brain).

Of course there is nothing no where near anything conclusive on this issue.

I may get screened for a PFO because the only conclusive thing I've been able to observe that triggers my migraines is a rapid change in head position. i.e. Sitting up quicking in the morning, bending over to pick something up etc.... But this is not always a trigger for me. My thought is maybe that is releasing microbubbles,emboli and the like that goes to my brain.

The question I have to ask myself what would I do if they do find a PFO? Should I get it fixed or not? Since my migraine frequency is 1 every 1-2 months. I am also concerned about potential damage to my brain that migraines may cause (some research suggest that this may happen).

 

[nereas]

...The question I have to ask myself what would I do if they do find a PFO? Should I get it fixed or not? Since my migraine frequency is 1 every 1-2 months. I am also concerned about potential damage to my brain that migraines may cause (some research suggest that this may happen).

Surgery these days is truly magnificent.

The nurses are all very nice and sweet to you, in the prep room, where they line up about half a dozen "roller-beds" (as I like to call them) each with a surgery patient on them. Then one after the other, these are then rolled into the operating room, a marvel of science technology with light panels on the ceiling, and with sophisticated biomedical equipment all around the room, as the local hopital performs its sequence of medical miracles for the day within the throbbing megalopolis of the modern city.

The doctors, interns, nurses, and aides are all gowned up in the purest white within the operating room, like angels, and as your bed is rolled in, they glance at you, presumably gauging your feelings, and your physiology, and reflecting upon their own roles in this, as they glove up, or adjust their gloves, a sort of unconscious behavior on their part.

They ask you to please slide over onto the operating table, and they take the bed out. The nurse adjusts your pillow for you, and makes sure you are comfortable, and rearranges your blankets, and then straps you in, like a seatbelt that goes across your abdomen and another across your legs. It is quite comfortable. By this time everyone is in their place, in a circle around you, and the anesthesiologist, whom you met earlier in the prep room, now tells you, "OK, I am going to put you to sleep now, OK?" And you nod, that it is ok.

In the next instant, a nurse in the recovery room tells you, "OK, its time to wake up now!"

It all happens in an instant!

The drugs that they give you afterwards to quell the pain work marvellously, being variations of morphine and coccaine.

So my point is, do not be afraid of surgery simply for surgery's sake. If there is a procedure that is applicable to you, and if it has a reasonable likelihood of success, and if you can get insurance approval, then I would definitely go for it, as soon as possible, and not delay.

I cannot speak for PFOs since I have never had one. But I am in favor of using surgery whenever needed to fix physical problems with your body. In a few weeks, you will be back to normal and even better than your former old self, best case!

Worst case, on the other hand, is that you shall face the ancient paradox of Christ on the cross, or of Achilles at Troy, that everyone dies, whether now or 50 years from now, and what does it really matter?

 

[TSandM]

I don't believe that one or two headaches a month would make a neurologist recommend PFO screening or closure. Despite nereas's glowing description of modern surgery, no invasive procedure is 100% successful or without complications, so one needs to be quite sure that the problem being solved is worse than the possible problems being caused.

Remember that, given the frequency of PFO in the population, there are probably a LOT of people out there diving with them and not getting bent. On the other hand, I don't know if anybody has looked at whether people with PFOs with migraines with aura have a higher frequency of Type II hits. Given the rarity of both situations, the intersection of the two groups is likely very small.

 

[Dr. Doug Ebersole]

Sorry to chime in late but I just got back from diving West Palm today.

There is definitely an association between "undeserved hits" and PFO. However, 25% of the population has PFOs but only 1/1000 dives results in DCS and a lot fewer with "undeserved" DCS. So there is no role for screening the general diving population for PFOs. If someone has an undeserved hit, it may be reasonable to screen them and close them.

As far as migraines go, as 25% of the population has PFO you would expect 25% of migraine headache patients to have PFO as well. However, there was an association found between improvement in migraines (with aura) when patients had their PFO closed due to a cryptogenic stroke (no other source found). This observation led to a randomized clinical trial which tried to show closing PFOs in these patients would be helpful. Unfortnately, the endpoint of the trial (called the MIST trial if anyone wants to search for it as I don't have the reference) was the incidence of COMPLETE resolution of migraines in the standard treatment arm versus the PFO closure arm. They were not able to meet this endpoint so it was reported as a NEGATIVE trial. However, a secondary endpoint of REDUCTION of migraines by 50% was significantly reduced in the PFO closure arm. There are other trials underway at the moment. The "party line" at the moment is NOT to routinely close PFOs for migraine. If someone has migraines with aura and a PFO and they want to be considered for closure they should be directed to a center involved in the trial.

Just my 2 cents as a cardiologist who closes PFO routinely for cyptogenic stroke and undeserved DCS hits (I closed three yesterday).

Doug

 

[TSandM]

Thank you very much, Doug, for your input!

 

[scubamickey]

If anyone is interested, DAN has a web based seminar on Decompression Illness that discusses PFOs. It is pretty good and discusses the association between PFO and DCS. Dr. Moon believes that while a PFO may be a factor, it is not the "smoking gun".

 

[Dr. Doug Ebersole]

A PFO probably increases your RELATIVE risk of DCS several fold but given the low incidence of DCS in general, the ABSOLUTE risk is still VERY small. Even if it raised the incidence 5-fold, the risk of DCS would go from 1/1000 to 5/1000 (or 0.5%). Definitely not worth screening the general diving population.

 

[TekDiveGirl]

On the other hand, I don't know if anybody has looked at whether people with PFOs with migraines with aura have a higher frequency of Type II hits. Given the rarity of both situations, the intersection of the two groups is likely very small.

Heh -- it's great always being the different kid on the block!! I belonged to all of those groups! Or should it be
??

And I agree testing every diver is a bit extreme -- but if you are going to be doing say more than 50 -100 dives a year or you are having other symptoms that don't seem right then absolutely get tested.

Just my opinion.