The project is about to close. After staying up for several nights, 34-year-old Ms. Wang has another severe headache. It had been several years, and this familiar feeling always appeared when she was physically tired and nervous, repeatedly. After doing various examinations such as head CT, no problems were found, but I was told to take a good rest. By chance, I discovered that the crux of the problem was actually in the heart – patent foramen ovale. A small, minimally invasive surgery can solve the problem.
Like Ms. Zhang and Ms. Li who were in a similar situation, both underwent interventional closure of the foramen ovale 2 years ago, and their headaches of unknown origin were significantly relieved.
What the hell is going on here? Listen to Wang Xiaowu, Director of Cardiac and Great Vascular Surgery, Pearl River Hospital of Southern Medical University.
“Feeling that the cerebral blood vessels are beating violently”
Headache is a common clinical symptom in daily life just like a cold and cough. There are various reasons. There are two types of headaches: primary and secondary headaches.
Director Wang Xiaowu explained that secondary headaches are headaches caused by other reasons, such as systemic infection, brain tumor, cerebral hemorrhage, etc.; To the cause, although it may not be fatal, it is especially life-threatening, such as the common migraine.
In the case of Ms. Wang, it is an intractable headache with no apparent cause. Usually, the pain is repeated and severe in the same part. Of course, some patients also have pain on both sides, the back of the head, or even the whole head. When the attack occurs, there is often a feeling of “the blood vessels in the head are beating”, and sometimes nausea and vomiting. The attack time may be as short as a few hours and as long as two or three days.
Why does a patent foramen ovale cause severe headaches?
What is the foramen ovale and why does a patent foramen ovale cause severe headaches?
Director Wang Xiaowu explained that there are four cavities in the human heart, which are called left atrium, left ventricle, right atrium and right ventricle from top to bottom and from left to right. Under normal circumstances, the atrium and ventricle on the same side are connected, but the atrium and atrium, ventricle and ventricle are blocked and cannot communicate. The fetus cannot breathe through the lungs, and a hole is formed between the two atria to ensure the normal circulation of blood in the heart. This hole is the foramen ovale.
Usually, the foramen ovale will gradually close between 5 and 7 months after the fetus is born, and the two atria cannot communicate with each other. However, various reasons, such as abnormal development, may cause the foramen ovale to not close in some people.
As for the cause of the headache caused by patent foramen ovale, Director Wang Xiaowu said that there is no clear explanation in the academic world at present. There are mainly three possibilities. One is that patients with patent foramen ovale have transient right-handedness. When left shunting, hypoxemia causes irritant migraine; it may also be that during deep breathing and coughing, the unclosed foramen ovale opens, and the tiny thrombus of the venous system enters the systemic circulation through the foramen ovale, causing cerebral ischemia and cerebral cortex. , leading to cortical spreading depression and a migraine attack; or when blood is shunted from right to left, the vasoactive substance serotonin enters the arterial system directly to cause a migraine attack.
Patent foramen ovale increases stroke risk
In addition to everyday headaches, patent foramen ovale is also an important cause of unexplained stroke, according to a growing number of studies , and is an independent risk factor. Statistics show that the detection rate of patent foramen ovale in patients with cryptogenic stroke under the age of 55 is as high as 40%-50%.
In fact, in clinical practice, patent foramen ovale is not uncommon, and the incidence of patent foramen ovale in general adults is about 20% to 25%. Usually, the diagnosis is made by ultrasonography, including transthoracic echocardiography, transesophageal echocardiography, and contrast-enhanced transcranial Doppler ultrasonography.
Does all patent foramen ovale cause severe headaches and must be treated? uncertain.
Director Wang Xiaowu said that when there are no obvious symptoms and no complications, regular outpatient follow-up is enough. However, if there is an unexplained stroke, cerebral ischemic attack, intractable or chronic headache, etc., it is recommended to treat as soon as possible according to the situation.
An effective way to treat this type of headache is to close the foramen ovale to avoid right-to-left shunting of the blood in the atrium! Currently, interventional closure of the foramen ovale is the main treatment method for patent foramen ovale. The simple explanation is that through the femoral vein approach, the occluder is sent to the designated location with a catheter to block the foramen ovale to prevent abnormal blood flow in the atrium.
Source: Pearl River Hospital of Southern Medical University
Correspondent: Wu Xiaodan
Editor: Lin Weimin
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