Migraine headaches following mitral valvuloplasty: Koch's postulates finally satisfied?

The relationship between patent foramen ovale and migraine headache is a topic surrounded by much controversy. We present the case of a 45-year-old woman who underwent successful percutaneous mitral balloon valvuloplasty for rheumatic mitral valve stenosis, but had an immediate postprocedural course complicated by refractory migraine headaches. Interestingly, resolution of her headaches coincided with the spontaneous closure of the interatrial communication created during valvuloplasty. This suggests interatrial flow as an important trigger for migraine headaches in this patient.