I read "Migraine Headache" (December 2008)* with interest because I've experienced migraine headaches for 18 years. In 2006, I noticed a change in my migraine pattern and characteristics. Testing demonstrated evidence of a stroke and a patent foramen ovale (PFO).

Having a PFO increases stroke risk by up to 25%. Research shows that a PFO and migraine are associated, and PFO closure can reduce migraine symptoms. After undergoing percutaneous PFO closure, I've had only one migraine. More importantly, my stroke risk is decreased.

Patients with migraine need to be taught to notify their healthcare provider of any change in their headache pattern or intensity and to call 911 if they experience unusual symptoms previously not experienced with a migraine, such as speech or vision problems, extremity weakness, or loss of balance.

Fran Merkle Carlino, RN

Saugus, Mass.

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