Migraine can be an extremely disabling condition that can destroy lives. It also has a huge social and economic cost burden to the community. Migraineurs that also have an ‘aura’ (visual or other sensory/neurological changes), have a much higher incidence of a PFO than the general population. These patients also have a much higher cure rate after closure of the PFO. The incidence of stroke in a patient with severe migraine with aura is much higher than the general population. Not all migraineures have a hole in their heart and not all hole in the hearts need to be closed. We are very experienced at assessing which patients will respond to PFO closure.
SCUBA Divers that suffer from migraine (particularly with aura) are at increased risk due to likelihood of an undiagnosed PFO/ASD. Decompression illness (DCI) or the ‘Bends’ are due the nitrogen gas accumulation in the blood stream, tissues and joints whilst diving at depth. Recreational SCUBA diving has a very good safety record because there is a strict adherence to dive tables and more recently advanced dive computers. However, there is a strong relationship between decompression illness (DCI) and the presence of a large patent foramen ovale (PFO). During and after resurfacing nitrogen off-gassing occurs mostly in the tissues and joints and venous circulation. In the presence of a PFO/ASD there is a direct communication to the arterial circulation. The more serious DCI such as cerebral arterial gas embolism (CAGE) or neurological/spinal DCI are more likely to be directly related to divers with a PFO.
The European and Northern American military screen their divers for PFO/ASD using transcranial Doppler with contrast. We recommend that all Commercial divers performing saturation dives as well as advanced and technical recreational divers that they be screened also. Anyone wishing to take up diving with a history of migraine with aura, unexplained stroke or heart attack should also be assessed and screened for a PFO. (as per section A4.8(c) of the South Pacific Underwater Medical Society (SPUMS) guidelines for recreational divers).
There are a few important considerations for divers:
1. Not suffering from migraine does not exclude you from having a PFO
2. Not all people or divers for that matter with a PFO need it to closed. There are different sizes and grades of PFO/shunt.
3. Even experienced divers with no DCI events to date can have an undiagnosed PFO.
4. After a successful PFO closure divers can resume normal activities within approximately 3 months.
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Coastal Heart & Vascular is a multidisciplinary team of specialists who provide
cardiology services and cardiac care.