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(Circulation. 2008;117:1358-1360.)
© 2008 American Heart Association, Inc.

Editorial

Migraine Intervention With STARFlex Technology Trial

A Controversial Trial of Migraine and Patent Foramen Ovale Closure

From the University of Colorado School of Medicine, Aurora.

Correspondence to John D. Carroll, University of Colorado School of Medicine, Leprino Office Bldg, B132, 12401 E 17th Ave, Aurora, CO 80045. E-mail john.carroll@uchsc.edu

Key Words: Editorials • heart defects, congenital • migraine • patent foramen ovale • trials

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Recent epidemiological data suggest that up to 18% of women and 6% of men worldwide have suffered a migraine headache.^1,2 Despite its common occurrence, our understanding of both migraine pathophysiology and the optimal means by which to control or abate symptoms remains severely limited.¹ For many years, the care of patients with migraines was left in the capable hands of general practitioners and neurologists. As information surfaced on the potential link between migraines and patent foramen ovale (PFO), however, some cardiologists became involved in the care of patients with migraines and were quickly humbled by the often debilitating nature of the disease process. Personally witnessing such intense suffering, the inconsistent effect of rescue medications, and the subsequent reliance on powerful intravenous narcotic agents to achieve some means of comfort until the storm subsides has been a sobering experience. With the development of implantable devices used to close potentially enabling PFOs, however, came a newfound hope in our ability to help these suffering people.

Article p 1397

The potential causative link between migraines and PFO became apparent between 2000 and 2004, during which period many single-center reports demonstrated precipitous improvements in migraine frequency in patients undergoing percutaneous PFO closures for nonmigraine indications.^3–5 When these preliminary reports surfaced, professional and media interest in this potential association escalated rapidly. This awareness established the groundwork for the Migraine Intervention With STARFlex Technology (MIST) trial, which, by incorporating important elements in trial design (eg, prospective, double-blinded, inclusion of a sham procedure), was viewed as an . . . [Full Text of this Article]

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