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Surgery for Migraine: Is it Worth the Risk?

Stories on a plastic surgery technique used to treat migraine made the rounds this month. Most articles present the surgery as a miracle cure, though Philly.com’s article Surgery for Migraines: Help or Hokum? provides a well-balanced look at the procedure. It notes that neurologists “generally remain not just skeptical of surgery, but disapproving.” In fact, the American Headache Society issued a statement urging patients be cautious in considering surgical treatments. The statement reads, in part,:

In light of recent news reports about the growing use of surgical intervention in migraine, the American Headache Society® is urging patients, healthcare professionals and migraine treatment specialists themselves, to exercise caution in recommending or seeking such therapy.

In our view, surgery for migraine is a last-resort option and is probably not appropriate for most sufferers. To date, there are no convincing or definitive data that show its long-term value. Besides replacing the use of more appropriate treatments, surgical intervention also may produce side effects that are not reversible and carry the risks associated with any surgery. It also can be extremely expensive and may not be covered by insurance. Most importantly, it may not work for you at all.

Since the occipital nerve stimulator I had implanted in 2003 proved ineffective, I swore I wouldn’t try to find a surgical solution again. (The nerve stimulator was my third migraine-related surgery, including TMJ surgery in 1997, sinus surgery in 2000.) The nerves of a migraineur are so sensitive that anything that mucks with them seems a bad idea.

That resolve lasted until earlier this spring when I found myself wishing for a hole in my heart (which I do not have). In a comment on that post, Drew shared his story of being diagnosed with a PFO and considering having it closed as a treatment for his NDPH (new daily persistent headache). Drew wrote,

“The research on this subject has led me and my doctors to one simple reasoning of thought. The proceedure is just not worth it. There is no garantee that closing the pfo will stop the headaches in the short term or long term over your life time. There is also the very possible chance that you could suffer even more complacations from the surgey, by no means is this surgey a fix it. Remenmber it still intails your heart and messing with the bodies system.”

The wisdom of Drew’s comment resonated when, days later, I saw the stories about plastic surgery for migraine. I must admit that initially my hopes were raised as I read about the surgery — I felt pretty bad and was wooed by the thought of relief. Then I remembered Drew’s comment and my own resolve and saw the AHS’s statement. No surgery for migraine has good evidence for efficacy and any surgery has potential complications and impacts the body in many ways.

I have re-resolved to avoid any surgical “fix” until it has strong support from scientific studies. The potential problems just aren’t worth the risks. What do you think of surgery for migraine? Have you had any (and was it effective)?

18 Responses to Surgery for Migraine: Is it Worth the Risk?

  1. Kate says:

    I think if I had a pfo I would go through with surgery. Same with an occipital nerve stimulator (actually working towards doing a trial currently, but only with leads to the front/suboribtal region added). I wouldn’t however do anything that involves severing or messing with nerves, like the decompression or plastic surgery type procedures. The risks of surgery alone are high enough. I think there is some limited data on some of these surgeries, but definitely not the stuff that is really needed.

    There have been some very small studies and anecdotal evidence on the occipital + suborbital nerve stimulator for constant headache like NDPH such that I think its worth the risks for me. The Reed and Omega procedures are getting some news, but other doctors will add the leads to the front too. I also like that you can do a trial procedure, but I know a lot of folks have a tough time knowing whether it is working for reasons such as procedure pain. I think a lot of folks go through with it hoping they will get better results than the trial. Best wishes.

  2. Shelby says:

    No surgery yet. I am trying Botox but unfortunately it only seems to duklnthe pain which delays my abortive medication so I haven’t found it effective. Have my next round a week from today, and then I think I will close the book on it. I was recently diagnosed with fibromyalgia which has made life with chronic migraine a world of fatigue and pain. You talked about having migraines and over sensative netves… I can relate. I stay sore for weeks after I get blood drawn, injections or a bump or bruise. I know this is not scientic terminology, but I find myself saying my nerves are over dramatic. They get all irritated for no reason.

    I am skeptical of many treatments because in the mix of severe pain I become desperate for relief. It’s easy to overlook the risks when you have 15 migraines a month or more but its wise to research what’s available.

    I keep thinking that out of all treatments out there it will only take the one right drug or change in diet and your better… But I know migraine is far more complex than that. More complex than many understand.

  3. Lisa says:

    It is probably worth waiting until there is more evidence that it will help and not harm. I agree that our nerves can be extra sensitive. However I would keep following it — and it’s good to know there might be more options in the future. Since migraine is so complicated there is probably not one easy fix is what I am realizing. Let’s all treasure each moment we are feeling semi decent and smile even if we don’t feel like it.

  4. Thanks for the great comments!

    Kerrie

  5. Adee says:

    I have almost daily severe migraine and have also developed fibromyalgia which presents as severe fatigue, cognitive issues and toothache like pains in my bones, down to my smallest toe bone.
    I’ve had a hole in my heart (PFO) closed – its was a good 1/2 inch tunnel in my atrial septum. It hasn’t stopped the migraines but has slightly lessened the severity and frequency (not enough to validate the surgery though. I’m glad i had it done though as it definately cuts my stroke risk.
    I’m perhaps having a hysterectomy to see if that has any effect on migraine. I’m really wavering about this because of long term effects on bone density etc but its so miserable having daily chronic migraine for me and my family I feel I have to try every avenue.
    I’ve tried almost every drug available, mouth guards, alternative medicine etc. Daily chronic migraine is crap.

  6. Marlene says:

    I had a PFO closure in 2006. For the first 6 months it seemed like it was really helping–I felt that my migraines were reduced by half. But after that they came back full force. However, like Adee I’m glad that there’s a reduced stroke risk. Plus, I feel pretty hardcore knowing there’s titanium in my heart. :)

    Chronic pain of any kind is crap — here’s to better days for all of us!

  7. Barbara Hamm says:

    My daughter has chronic intractable migraines since she was 11 and is 34 now. For the last 16 – 17 yrs the severe pain is constant with no stopping. The pain ranges from a 7 to a 10 on a 10 point scale. The severity is most usually an 8 or 9. She has taken every medicine and combination of medicines available including having a pain pump with the medication Prialt (from a poisonous sea snail) with no improvement. She also had a hysterectomy but that did not help at all either. We were considering the Omega Procedure but medicare does not cover it and the cost is enormous ($55,800) and it is not FDA approved at this time. So we wait….

  8. arlene says:

    THE PROBLEM WITH DIET FOR MIGRAINE,CAN BE TRICKY.

    YOU MAY FIND YOURSELF HOPPING FROM ONE FOOT TO ANOTHER.
    TRYING TO FIGURE OUT WHAT YOU AT THIS TIME THAT TRIGGERED A MIGRAINE.

    AND…WHAT TRIGGERS A MIGRAINE ONE TIME, MAY NOT TRIGGER IT ANOTHER.

    THEN, JUST WHEN YOU THINK YOU HAVE YOUR DIET AND TRIGGERS UNDER CONTROL…THERE YOU GO, ANOTHER MIGRAINE, AND YOU ARE LEFT, ONCE AGAIN, TRYING TO FIGURE OUT WHAT YOU ATE.
    AFRAID TO EAT ANYTHING AT TIMES.

  9. Melinda says:

    I have been suffering from migraine and daily headaches since I was 10 years old. I am now 37 and I have tried every medication and numerous other treatment options. I am beyond sick of drs treating me like a druggie. I cannot take pain medication because 99.9% of the time any pain medication will give me a migraine. If I do take a pain medication then it shows that I am in serious pain. I broke my ankle and only room 2 of the pain pills prescribed to me. I also fractured my sternum, serverly bruised my ribs and heart and have to say that was the most pain from an injury that I have ever been in. Taking a small breath was excruating and was that way for nearly a month and year again I went without the pain medication because I will do ever what I have to do to avoid getting a migraine at all cost. I know what foods and scents trigger a migraine for me and stay away from those things. It is severely irritating to tell a doctor that all u want is to find something anything to get just the slightest amount of relief and that if u owned a gun that you would probably blow your brains out because the pain is so bad and for them to continue to tell u it’s this that causes them or its that when u have said over and over that its not possible or to be treated as if u are a drug seeker. It would be amazing to find a doctor that had actually had a migraine before. Unless a person has had a migraine before then that have no clue what it is like and how they ruin ur life. I had a hysterectomy when I was 26 and it did nothing what so ever for my migraines or headaches. The hysterectomy was not for the reason of treating my migraines. I can honestly say that I would try anything and do any and every surgery that there is, any new medicine if there was a fraction of a chance that it would only cut out 1 of my migraines. I would not care what the side effects were, what the long term outcome would be or even if it would kill me because the migraines are killing your spirit and ability to have any sort of enjoyment out of life. It may be wrong to think of things that way but I do not know of any other way to feel because my migraines control every single thing I do. I have missed out on so many special things with family and friends because all I can do is go to the darkest and quietest place I can find and endure the hell that is a migraine. 95% of the time my migraines come on without any warning and often last for days upon days. Right now I am on day 10 of a migraine that will ease up to a severe headache only to come back twice as bad. I have to continue to work and do everything else that needs to be done regardless of the pain. I know that I cannot be the only one out there that deals with this sort of thing. I can only hope that one day I will be able to find that miracle for relief even if it is just the smallest amount. As I hope that anyone who suffers from migraines will be able to get some sort of help.

    ********
    I’m sorry to hear you’ve struggled so much and are in a bad migraine attack right now. I hope you are getting good medical care and are able to see a headache specialist. Hang in there. There are so many treatments available, you will find an effective one eventually – even if it feels like it takes forever to get there. After 10 years of being dismissed by doctors, then 10 years of trying more than three dozen preventives and a slew of other treatments that had no effect, I’ve finally find a combination of supplements, medications, and diet that has reduced the severity of my attacks significantly. I truly believe there’s an effective treatment for everyone… it is just a matter of finding the right one.

    Take care,
    Kerrie

  10. Dave says:

    Does anyone know of information on the “Omega Procedure” and the Migraine Centers of America? I’m looking for first person experiences pro and con much like the ones you see when you reserve a hotel room online.

    • That would be really helpful, but I’ve never seen as such. People talk about nerve stimulators on forums and Facebook, but don’t always say where their surgery was. Some people love their nerve stimulators, others regret having done the surgery — those are the two most vocal groups you’ll find online. Migraine Centers of America is focused on surgery and really only treats patients who are surgical candidates. Best of luck in finding information. Please let us know if you come across a good source for reviews.

  11. Justin says:

    Please check out the external, portable nerve stimulator just approved for use in the USA by the FDA. http://Www.cefaly.us
    Requires a prescription from your dr. I’m going to try it. I have almost daily chronic migraine and have tried almost everything except nerve stimulation. I’d prefer something like cefaly that is non-invasive over surgery.

  12. Freida says:

    Has anyone had, or know personally of someone who’s had, the surgery where they either take out or clip muscle and/or nerves for migraines? I’d appreciate pros and cons on that also. I have chronic, daily migraines that are controlling my life, and I’m seriously considering it. I’ve seen a doc at UT Southwestern in Dallas, TX who does this type of surgery. Thanks for all comments.

  13. Teena says:

    Our daughter had nerve decompression surgery in 2011. Her story is at http://www.mydaughtersheadache.com
    She got her life back and will be startng Pharmacy school at Purdue in the fall.

  14. Mary Ellen says:

    I don’t know if I”m too late to get in on the conversation but here goes. I had the Omega procedure Dec. 30, 2013. I suffered from chronic basilar type migraines for 42 years. I took every kind of medicine you can imagine, including injections directly into the occipital nerves but nothing ever really helped. I did take some anti-epileptic drugs which kept the headaches away but the side effects were so severe I stopped taking all of the medicines. I now take Celexa every day which helps with my milder headaches.
    I had the procedure and can tell you that it worked for me. If I can catch my headache at the start (some being during sleep) I turn on my device and get 100% relief usually within 10 minutes. I leave the device on for the next several days until the migraine is gone. During extremely severe migraines, I only get about 50% relief. However, I only take about half of the drugs that I would have normally taken to help take the edge off the pain. I am now able to participate in life again, even when my headaches are severe due to the pain relief. I simply charge my battery about once a week (it’s in my lower back) and that’s it. Turning it on and off is as easy as using a remote control and some ppl leave it on all the time.
    Cons: lead migration is probably one of the biggest. I do have one lead that has slipped out of place but since I don’t really need that one, it’s no big deal to me. To fix it requires another surgery to replace it in the correct part of my head. There is no lifting or stretching for several months. You will never be able to have an MRI unless you get an MRI friendly stimulator. Recovery time was easy for me but I know some ppl have a rough time with the pain for about a week or so. The biggest hurdle you face is that your insurance company may refuse to pay. It took about a year for me to get mine approved and then,after my surgery, they decided not to pay for most of it. However, I was only charged my copay amount by the doc and hospital and they simply forgave the rest of the bill. You need to carry your little remote with you and take your charger with you if you go on a trip. I carry my remote to work (and back home) and just keep it stowed in my desk in case I need it. Other than that, I have LOVED having it and would do it again in a heartbeat. It does not work for everyone, though, so I did have to do a four day trial procedure before having a permanent implant. If you have further questions, I’d love to answer them as much as I am able.

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