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To the Editor:
Schwerzmann et al.1 found that closure of patent foramen ovale (PFO) reduced the frequency of attacks by >50% in migraine patients with aura (MA+) and without aura (MA−). These authors suggest PFO closure for prophylaxis of migraine and recommend a prospective trial.
The incidence of migraine headache in patients in the year prior to PFO closure was twice the expected prevalence.1 Stress is one of the most common precipitants of migraine attacks.2 The cerebral and peripheral events associated with PFO in these patients1 are significant medical occurrences correctable only by invasive intervention. To exclude event-related stress, the incidence of migraine attacks prior to the event, diagnosis of PFO, or both, must be determined.
Secondly, the >50% reduction of migraine attacks following PFO closure1 is statistically significant but biologically debatable. The placebo responsiveness of patients with migraine is increased. Inclusion of migraine patients with as few as two attacks per month in the …
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