I was surprised by a newspaper story that pictured a car restorer over the caption, “Surgery to repair a hole in his heart also stopped migraines that had bothered him for decades.” This was news to me so I thought it was time to look into the issue and get educated. Here’s what I learned.

A number of studies have now shown that migraine headaches, particularly ones associated with aura, are more frequent in people who have a hole in the wall of the heart between the right and left atrial chambers. This defect, called patent foramen ovale (PFO), is present in the fetus and ordinarily closes at birth. But it’s common for a PFO to remain beyond infancy and an estimated 70,000 strokes occur each year in the U.S. because of the defect. These strokes are thought to occur because blood in the right atrium can contain small blood clots that are usually filtered out as blood passes through the lungs. A PFO allows blood from the right atrium, which may carry these clots, to enter the left side of the heart and be carried to the brain, where they can obstruct small arteries.

A PFO can be closed with a minor surgical procedure in which a catheter is threaded into the heart. Several studies of PFO closures involving 205 patients with a history of strokes report that migraine headaches (with and without an aura) were reduced or completely eliminated in a significant number of these patients after surgery. In at least one study, however, other types of headaches were unchanged.

If you are one of the estimated 2.5 million people in the U.S. who have at least one migraine attack per week, do these findings mean you should rush to a cardiologist to learn whether you have a PFO? Certainly not. It would be a good idea only if you have had an unexplained stroke. None of these studies was randomized or controlled, all of the patients in the studies had had prior strokes, the follow-ups were short, and the results may have been affected by the placebo effect and the desire of the surgeons to see this benefit.

Randomized controlled trials of PFO closure are planned. If they show the same positive effects, then a trip to the cardiologist would be in order.