Patent Foramen Ovale

[Roger Reverser]

I have occasionally in my life suffered from migraines with aura.

Recently, on a scuba diving holiday I had two severe migraines with aura after diving. I also suffered mild, but clear symptoms of decompression sickness. All dives were well within standard limits.

I have now read that this is a strong indicator of patent foramen ovale.

My questions are;

Should I have this investigated? (I understand that 25% of the population have PFO)

If I do have a PFO will it affect my JAA medical?

Will it affect my medical if I have the PFO closed?

Thanks

Roger

[gingernut]

The opinion that closing or part closing pfo's may improve migraine symptoms, is based on small scale studies, at the moment. (Which means its difficult to base decisions on.)

Interesting area of research, but sorry, I can't advise you of the specifics.

More on migraine here... migraine - General Practice Notebook (http://gpnotebook.com/simplepage.cfm?ID=-1670709238)

Check out pfo's on the site to.

[nannodnai]

Should I have this investigated?
On the basis of the present situation, as described, the benefits of possibly invasive further investigation would be dubious, to say the very least.
If I do have a PFO will it affect my JAA medical?
If it is not proven, not documented, not known, and therefore probably not even suspected . . . . . . . . the answer is NO.
Will it affect my medical if I have the PFO closed?
Definitely, YES. Any major op under GA needs to be declared, and will result in being made T/U, albeit only for a short time.

All in all, if I were you, I would adopt a "wait and see" approach. As with all medical things more information may come to light before long. But, right now, you risk opening up the proverbial "hornets' nest"; and just getting . . . . . . . . stung ! !

[Loose rivets]

It was a strange thing, but soon after reading the first reports of the distressed heart releasing a migraine-triggering hormone, I was chatting to a friend about it. I knew that he'd suffered from classical migraine all his life, and was astonished to hear him say that he'd just been diagnosed with this heart condition. At 60, he was very fit...running and swimming regularly. He never had a clue that he had a heart 'condition'.

Despite the above, my friend was a 'classical' case in the other sense. His worse time for migraine was when his company was ailing, and he was in danger of losing his home...and indeed, a lot more. It so often seems that the triggers are secondary to the main cause. A fulfilled and active period in One's life often leaves a patient free from migraine for a while. When things turn bad, migraine cuts in just to make matters worse.

You would need a lot more than two times to come to any conclusion about diving being a trigger...but I wouldn't rule out a link. I knew a trumpeter that had to give up playing, presumably because of the affects of blood vessels bulging in his head. Again, a perceived threat.


Please bear in mind that migraine with aura was a license loser. I gather it's now not so cut and dry. Multi-crew operations would seem to be a logical requirement.

[nannodnai]

Thanks, Ginge ! Yes, you're right, LOL !

Here, too, is further professional advice NOT to interfere if it can be avoided ( that good old northern saying : "if it ain't broke, don't fix it" ! ) :
On March 3 2008, the journal Circulation published the results of a the first such randomized clinical trial, the MIST trial. The study was entirely negative. Closing PFOs in patients with severe migraines did not affect the headaches in any way

That's just one of many similar items I found in cardiology and other related sites.

[Loose rivets]

I'm sad to read that. Sometimes even just knowing there's an escape route helps the sufferer.

[air pig]

Hi

Do NOT scuba dive until you have an Echo cardiogram and have spoken to someone like London Dive Centre or Diving Disease Research Centre. (DDRC) If you have a PFO you are at risk of Arterial Gas Embolism leading to a stroke or worse. Ask GP for a referral for an Echo if necessary pay for it privately. I reiterate DO NOT dive until you have seen a doctor experienced in Cardiology and Diving.

Scuba diving even within tables and limits does not preclude Decompression Sickness (DCS) as any dive doctor or instructor will tell you. There are too many variable factors involved in DCS, such current medical condition, dehydration injury tiredness and repetitive diving over days.

A PFO can be closed with an Amplatzer device by using a catheter based approach without the need for Open Heart Surgery.

Regards, flying and safe diving.

Air Pig

[Pudnucker]

My wife suffered with terrible cluster migranes for about 5 years. She found out about the possibility of a PFO and went and got tested for it. Surprise surprise, she had a hole between two chambers and a lot of blue blood was going up to the brain. She had the PFO closure and is totally cured now - not one migrane in two years.

She went to a very very good specialist on Harley St (Dr Stephen Brecker) and would highly recommend it.

Whenever she mentions a previous heart issue, eyebrows are raised but her doc has now had it added to her records that the closure is now fully healed up and is fully cured = no problem.

It was a very easy ultrasound test to see if she had a PFO and the op was done key hole stylie up a vein in her leg. She was home next day.

P