As long as the fetus is in the mother’s womb, the lungs are inactive. It is the mother who sends oxygen through the placenta and the vessels of the umbilical cord. In intrauterine life, blood passes from the right side of the heart to the left through two openings, the Botallo duct and the foramen ovale. This “passage”, in particular, connects the two atria, the highest heart chambers. At birth, however, the pressure play that is created progressively closes this last weld, in a process that ends in the first year of life.
A hole in the heart
In some, however, this welding does not occur completely. In these cases we speak of patent foramen ovale (PFO). In short, a kind of “hole” in the heart, which, moreover, can create disturbances in the flow of blood and therefore potentially favor the formation of clots. It is also known that in migraine sufferers with aura this condition appears more frequent.
The relationship between migraine and hole in the heart
Now an Italian research explains for the first time the mechanisms that link the cardiac anomaly and this form of headache. The study was conducted by experts from the Monzino Cardiology Center and the State University of Milan and was published in the Journal of American College of Cardiology Basic to Translational Science. The study, in addition to shedding light on the pathophysiological mechanism that correlates migraine with aura to the congenital heart defect of the Foramen Ovale Pervio – commonly called “hole in the heart” also confirms that in about seven cases out of ten intervening with interventional cardiology techniques (in practice you go to “close” the abnormal duct) you can get a decrease in migraine crises.
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The starting point is that about 35% of people with PFO suffer from migraine with aura (70% are women) and that in these patients the migraine attacks disappear or are significantly reduced after the interventional closure procedure. of the foramen. But until today it was not known why there was this relationship. “To date, none of the international cardiology guidelines include migraine with aura among the indications for PFO closure surgery.
The discovery
Yet it is a disabling disease, which in many cases does not respond to drugs and occurs incessantly for days, once or even more times a month, preventing normal everyday life and planning of life – he explains Daniela Trabattoni, Head of the Interventional Cardiology Unit 3 of Monzino, and coordinator of the clinical part of the study. We found that the blood of subjects with migraine and PFO has a high number of platelets and microvesicles that express a protein – tissue factor – capable of triggering the coagulation cascade and thrombus formation. This state of platelet activation is caused by oxidative stress (caused by free radicals), a well-known condition for altering the functions of our cells and tissues “.
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“In our organism the action of free radicals is counteracted by antioxidant substances, but in some conditions, such as in patients with PFO, these may not be sufficient to maintain an oxidative balance, consequently determining platelet activation with the formation of micro-emboli”, adds Marina Camerahead of Monzino’s Cardiovascular Cell and Molecular Biology, who coordinated the pharmacological-molecular part of the study.
The role of aspirin
The LEARNER study (pLatelEts and migRaine iN patEnt foRamen ovale) analyzed 62 patients symptomatic of migraine with aura on cardioaspirin therapy before surgery and 6 months after percutaneous closure of the PFO. “We found – underlines Trabattoni – that aspirin improves migraine attacks with aura, but does not resolve them, while closure achieves complete regression in 69.7% of cases”. Obviously, the presence of the patent foramen ovale (often not even identified because it does not show signs) should not be monitored only for those suffering from migraine with aura. The PFO could in fact allow in some situations the passage of thrombi from the right to the left atrium, and thus towards the cerebral circulation, favoring the onset of ischemias and increasing the risk of stroke. The defect is treated, in the event of an ascertained presence of an increased thrombotic risk, with antiplatelet drugs, such as acetylsalicylic acid and clopidogrel, or with transcatheter surgery to close the foramen.