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A specialist in Pediatric-Congenital Cardiology in Antalya Turkey, said that research has shown that the Patent foramen ovale, the name of a small hole found in our heart, increases migraine twice as much, and that the frequency of migraine attacks decreased by 80% after the closure of the Patent Foramen ovale.

What is migraine headache?

Migraine headache is a complex disease and its frequency is reported between 8-13% in various studies. It is thought to be caused by genetic and environmental factors. It is monitored three times more frequently in female patients. 3 in female patients. its frequency increases over the decade, and its frequency decreases as age increases. In men, its frequency does not change with age.

On average, a migraine patient experiences problems due to headache for 3 days within a 3-month period. An effective treatment is very important, as migraine attacks affect quality of life, affect Turkey work and social activities, family relationships in Turkey in a bad way.

Migraine Types, What is migraine with Aura?

Migraine has simple and “aura” types. In addition to headache in simple migraines, there are no other signs of the central nervous system. Some patients develop visual precursor symptoms before an attack. These attacks are called “aura” migraines, and approximately one-third of patients with migraines have “aura” attacks.It is rarely seen in attacks with aura, where the muscles and sensory system are affected.

It is suggested that temporary depression causes aura in neuronal activation, which occurs after arousal in the cortex layer of the brain. It is believed that an increase in blood flow after a decrease in blood circulation also leads to this. An abnormal condition caused by metabolic substances acting on the vessels, such as Serotonin, and signals formed by embolisms of a microscopic diameter, causes the onset of a migraine attack with Aura.

Relationship between Patent foramen ovale and migraine with Aura

The Patent foramen ovale (PFO) is the name of a small opening in our heart. Before birth, there is a transition between the two atria of the heart, which is necessary for life. From this opening, clean blood passes from the left atrium of the heart to the right atrium. But because this transition is very small, it does not pose a health problem. In studies, it is reported that the probability of occurrence in adult individuals varies between 20-25%.

In patients with migraine headaches, it is known that the rate of PFO increases twice as much.In various studies, it is reported that the rate of patent foramen ovale increases further in migraine cases with Aura.Oral blood thinners and low-dose aspirin therapy have been shown to reduce the frequency of migraines and migraine with Aura. These observations reinforced the hypothesis that the passage of clots from the PFO from the right atrium to the left atrium potentially triggers migraine attacks. Again, it is known that the frequency of migraine attacks decreases by 80% after closing the foramen ovale.

There are some theories put forward to explain the Association of PFO with migraine attacks

• It is suggested that the passage of microscopic clots of no clinical significance through this opening into the systemic circulation without entering the lungs leads to stimulation in the brain, triggering migraine.

* In the presence of PFO, a metabolic substance called serotonin, which participates in the systemic artery circulation without going to the lungs, can trigger migraines by joining the brain circulation.

* It is suggested that oxygen-poor blood passing from the right atrium to the left atrium through PFO can cause stimulation and migraine by causing temporary low oxygen levels in the brain and micro-blockages in the brain vessels.

How is PFO diagnosed in migraine patients?

It is not possible to diagnose the Patent foramen ovale by physical examination. In selected patients with migraine attacks with aura and severe headache problems, the presence of patent foramen ovale can be investigated by echocardiographic examinations. Since Normal echocardiographic examination does not provide very clear imaging in adult patients, echocardiographic examination (transesophageal echocardiography) should be performed from the esophagus in these patients. During this process, this transition from the right atrium to the left atrium can be monitored by injecting serum from the veins of the arm balls.

It is a method used for Transcranial Doppler scanning and shows the presence of PFO in a indirect way. Agitated serum given from the balls in the arm is made by measuring the ultrasonic signals created in the brain artery. Although it is more comfortable method, diagnosis should be finalized with echo cardiography when the test is positive.

Does PFO shutdown reduce migraine attacks?

According to the information we currently have, it is reported that migraine attacks are lost or significantly reduced in patients who have been closed PFO for another reason. A study conducted on this subject reported that migraine headache attacks decreased in number after closing PFO with an umbrella in all migraine groups, but did not reach a statistically significant result. Again, in the same study, a statistically significant result was achieved in cases of migraine with aura, as well as a decrease in attacks. As a result of the evaluation of the secondary results of these studies, it is concluded that PFO closure may be recommended in migraine cases with Aura. For this reason, it should be considered that closing PFO with an umbrella will benefit in selected cases of migraine (migraine with Aura).

How do you turn off PFO?

In ancient years, this closure process was closed by surgical method, while since the last 15-20 years, this process can be done very easily with umbrella-like implants and has become the preferred method. Often nitinol-based umbrellas are used. This implant in Turkey is carried out through a small catheter into the heart and closed. Due to the easy application technique, very low risk of complications, these devices can be applied safely.The procedure is performed under anesthesia. After the appropriate device diameter is determined by echocardiography, the umbrella is placed in the desired area by means of a long sheath placed through the inguinal vein.

Apart from nitinol-based umbrellas, devices made with PTFE material attached to a metal frame are also used for closing today. In recent years, it has started to be closed with stitches by entering the groin without inserting an implant into the heart. The long-term results of this method are not yet known.

What happens after the PFO is closed with umbrellas?

After the procedure, the patient can go home the next day. After a few days of rest at home, they can return to their daily activities. Situations that cause them to take blows for 6 weeks and contact sports (such as karate, boxing, wrestling, weightlifting) should be avoided. It is recommended to use aspirin and similar drugs for 6 months and to protect against infections. Regular checks in Turkey by Turkish care doctors are performed at increasing intervals. The possibility of problems during long follow-up time is very rare.

Migraine headache and patent foramen ovale, conclusion:

* It is known that the frequency of migraines increases in patients with PFO, or the incidence of PFO increases in patients with migraines.

* However, the relationship between migraine and PFO has not been fully clarified.

* Early results of PFO closure in migraine patients are laughable. Although detailed studies found that the number of attacks decreased or disappeared, the primary results in all migraine groups were not statistically positive.

* Therefore, our evidence is insufficient to routinely apply PFO closure as a general treatment in migraine patients.

* But when the secondary results of these studies are evaluated, it is believed that PFO closure may be useful in migraine cases with aura.

* We believe that with the full demonstration of this relationship with large-scale research in the coming years, it will be known for sure which type of migraine patients will benefit from PFO closure.


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President of Organ Transplant Center at MedicalPark Hospital Antalya

Turkey's world-renowned organ transplant specialist. Dr. Demirbaş has 104 international publications and 102 national publications.

Physician's Resume:

Born on August 7, 1963 in Çorum, Prof. Dr. Alper Demirbaş has been continuing his work as the President of MedicalPark Antalya Hospital Organ Transplantation Center since 2008.

Prof. who performed the first tissue incompatible kidney transplant in Turkey, the first blood type incompatible kidney transplant, the first kidney-pancreas transplant program and the first cadaveric donor and live donor liver transplant in Antalya. Dr. As of August 2016, Alper Demirbaş has performed 4900 kidney transplants, 500 liver transplants and 95 pancreas transplants.

In addition to being the chairman of 6 national congresses, he has also been an invited speaker at 12 international and 65 national scientific congresses. Dr. Alper Demirbaş was married and the father of 1 girl and 1 boy.


Eczacibasi Medical Award of 2002, Akdeniz University Service Award of 2005, Izder Medical Man of the Year Award of 2006, BÖHAK Medical Man of the Year Award of 2007, Sabah Mediterranean Newspaper Scientist of the Year Award of 2007, ANTIKAD Scientist of the Year Award of 2009, Social Ethics Association Award of 2010, Işık University Medical Man of the Year Award of 2015, VTV Antalya's Brand Value Award of 2015.


Doctor of Medicine Degree Hacettepe University Faculty of Medicine Ankara, General Surgeon Ministry of Health Turkey EKFMG (0-477-343-8), University of Miami School of Medicine Member of Multiple Organ Transplant, ASTS Multiorgan Transplant Scholarship. Lecturer at Kyoto University. Lecturer at University of Essen, Research assistant at the University of Cambridge .

Professional Members:

American Society of Transplant Surgeons, American Transplantation Society Nominated, Middle East and Southern Africa Council Transplantation Society 2007, International Liver Transplantation Association, Turkish Transplantation Association, Turkish Society of Surgery, Turkish Hepatobiliary Surgery Association.


Our website contents consist of articles approved by our Web and Medical Editorial Board with the contributions of our physicians. Our contents are prepared only for informational purposes for public benefit. Be sure to consult your doctor for diagnosis and treatment.
Medically Reviewed by Professor Doctor Alper Demirbaş
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