Patent Foramen Ovale and Migraine

Patent Foramen Ovale and Migraine

Finding PFO

PFO incidence

PFO incidence in migraine

Closing the shunt

Comment

The foramen ovale is a channel between the atria of the foetal heart allowing blood to flow from the right to the left atrium, which shunts oxygenated blood to the systemic circulation during foetal development. It is not needed in adult life when the lungs are functional, and closes after birth. Or at least it closes most of the time, because defects in the septa between the atria are relatively common, and a significant minority of adults have a patent (open) foramen ovale.

Patent foramen ovale (PFO) is associated with increased risk of stroke. In recent years it has also been associated with migraine. While closing a large PFO to try and prevent stroke might make sense, cardiac surgery to prevent migraine, however bad, is difficult to justify.

This short article examines some of the literature on PFO incidence, and takes a quick look at the current evidence on PFO closure and the effects on migraine.

Finding PFO

There are two main methods. One is to look at the heart directly, usually after death. When patients are alive, the main method is transoesophageal echocardiography (TOE). The first question is whether these two methods give the same answer, and whether they are diagnostically equivalent. The answer [1] is that they are.

Briefly, 35 consecutive patients with prior TOE who died underwent a post mortem examination of the heart. Post mortem PFO was found in 9/35, and TOE picked up the same nine. Moreover, both methods gave the same PFO diameter (Figure 1). We might expect case series using either method to give the same result, therefore.

Strengthening the Core Muscles

Strengthening the Core Muscles
There are many exercises that will strengthen the core, as well as exercise equipment that will aid this training. Some of the best products for developing core strength include:

• Medicine Balls
• Kettlebells
• Stability Balls
• Balance Products such as the Bosu Ball, Swiss Ball, balance boards, wobble boards, Sit-fit and others
• Dumbbells

No Equipment Core Strength Exercises
Body weight exercises are very effective for developing core strength. They are also the type of exercises many athletes and coaches rely on for regular core training. They include:

• Abdominal Bracing
  This is the main technique used during core exercise training. It refers to the contraction of the of the abdominal muscles. To correctly brace, you should attempt to pull your navel back in toward your spine. This action primarily recruits transverse abdominus. Be careful not to hold your breath – you should be able to breathe evenly while bracing.
• Plank Exercise: Start Position | Finish Position
• Side Plank Exercise: Start Position | Finish Position
• The Basic Push Up
• V-sits
• Push Ups
• Squats
• Back Bridge
• Hip Lift
• Russian Twists
• Lunges
• Side Lunges
• Back Extensions

Other exercises that develop core strength include exercises on a stability ball, work with medicine balls, wobble boards and Pilate's exercise programs. Yoga is also an excellent way for athletes to build core strength. For a simple core strength program you can begin with push-ups and crunches, but work with your physio to find the exercises that work best for you.

William Enness is fundraising for Cystic Fibrosis Trust - JustGiving

William Enness is fundraising for Cystic Fibrosis Trust - JustGiving


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Core Strength Training and Athletic Performance

Core Strength Training and Athletic Performance
Because the muscles of the trunk and torso stabilize the spine from the pelvis to the neck and shoulder, they allow the transfer of powerful movements of the arms and legs. All powerful movements originate from the center of the body outwards, and never from the limbs alone. Before any powerful, rapid muscle contractions can occur in the limbs, the spine must be solid and stable. The more stable the core, the most powerful the extremities can contract.

Training the muscles of the core also corrects postural imbalances that can lead to injuries. The biggest benefit of core training is to develop functional fitness - that is, fitness that is essential to both daily living and regular activities.

Core strengthening exercises are most effective when the torso works as a solid unit and both front and back muscles contract at the same time, multi joint movements are performed and stabilization of the spine is monitored.

Strengthening the Core Reduces Back Pain

Strengthening the Core Reduces Back Pain
Abdominals get all the credit for protecting the back and being the foundation of strength, but they are only a small part of what makes up the core. In fact, it is weak and unbalanced core muscles that are linked to low back pain. Weak core muscles result in a loss of the appropriate lumbar curve and a swayback posture. Stronger, balanced core muscles help maintain appropriate posture and reduce strain on the spine.

If you have back pain and you require an assessment contact me on enquiries@pro-physio.co.uk