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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)?

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Traditional & “Sham” Acupuncture Both Effective for Migraine Relief

I don’t normally republish press releases without further investigation, but I’m going to today because 1) It is from the American Headache Society and quotes my headache specialist, whom I trust immensely; 2) It provides a novel, scientific perspective on why acupuncture may help migraine (the focus is on endorphins and the effect they have on inflammation and pain signals, not the usual talk of meridians and energy flow); and 3) I have a killer migraine.

American Headache Society Supports the Use of Acupuncture in Migraine Treatment: Both Traditional Acupuncture and “Sham” Acupuncture Provide Relief

Mt. Royal, NJ (February 1, 2012) – When it comes to treating migraine, so-called “sham” acupuncture (where needles are inserted only to a superficial depth in the skin and not in specific sites) and traditional acupuncture where needles are inserted in specific sites, both are effective, according to the American Headache Society (AHS).

Citing publicity surrounding a recent Canadian study comparing the effectiveness of the two types of acupuncture, David W. Dodick, MD, AHS president, said both types of acupuncture, particularly when electrical stimulation is involved, may work to release endorphins that are important in controlling signals of pain and inflammation.

“How much of a benefit sham acupuncture can have on the release of these chemicals is unclear,” he said. “This suggests the benefits of treatment may not depend on the exact technique of acupuncture and needle positioning.”

There is ample evidence supporting the value of acupuncture in migraine treatment, Dr. Dodick noted, including four studies that compared acupuncture to standard migraine preventive medications. Acupuncture was found to be at least as effective and produced fewer side effects.  Further, he noted that a randomized clinical trial study published in November comparing acupuncture to topiramate in chronic migraine prevention showed that acupuncture was more effective than topiramate. Topiramate is an anticonvulsant often used in epilepsy.

Dr. Dodick said that needle positioning may be less relevant than acupuncturists believe, and acupuncture should be offered to patients as part of their options for migraine management.  “Further, the long-lasting effects of acupuncture, given that subjects continued to experience a reduction in migraine frequency two months after treatment, is also noteworthy and not a point to be ignored,” he said.

“Along with biofeedback training, cognitive-behavioral therapy, and lifestyle changes, acupuncture provides some migraine sufferers with a safe, non-pharmacologic treatment choice, and one that can also be used during pregnancy,” Dr. Dodick said.

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Seattle Doctors, Neurologists & Headache Specialists

I’ve been asked about Seattle headache specialists and neurologists more times than I can count in the last month. My experience is quite limited, but the online support group and forum has a thread with recommendations for Seattle headache doctors. If you have any to add, please do! You can also check What Do You Think of Your Doctor, an earlier post with lots of good suggestions, some in Seattle, some elsewhere.

Here’s what I know:

I’ve seen Sylvia Lucas at UW and Sheena Aurora at Swedish. They are both kind and caring. We all click with different people, of course, but I found Dr. Lucas to be more patient-oriented and Dr. Aurora to be more research-oriented. Both have at least three-month long waiting lists. It took six months to get into my first appointment with Dr. Lucas and follow-ups are usually scheduled two months out. Dr. Aurora is more like three months for an initial appointment.

A friend sees Patrick Hogan, an osteopathic neurologist, in Tacoma. His number is (253) 284-4488. He requires a doctor’s referral regardless of your insurance and your family/general physician will have to contact his office to get you in.

For other doctors in the Seattle area — or anywhere else in the US, check the National Headache Foundation’s physician finder or the American Headache Society’s health care provider search.

8/14/14: Many readers have lamented Dr. Elena Robinson‘s move to Vancouver. She’s back in Seattle and is in practice with the University of Washington.

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AHS to Host Public Forum in L.A.

The American Headache Society‘s annual meeting began today in Los Angeles. On Sunday, July 25, findings presented at the scientific meeting will be shared in a public forum. The session will be held from 10:30 a.m. to 12:30 p.m. at the Hyatt Regency Century Plaza.

The scheduled topics are:

  • What’s new in the study and treatment of headache
  • Migraine and headache in children
  • Chronic daily headache: Who gets it and why?
  • Ask the experts: Answers to your questions

The first sentence of the event press release is “About 28 million Americans – including actor Ben Affleck – suffer from migraine headaches and could benefit from a discussion of the latest advances in headache research and treatment.” Even the AHS knows the importance of a celebrity face.

If you live in L.A., I highly recommend working this meeting into your schedule. To register, call (800) 255-2243 or e-mail achehq@talley.com. For the rest of you, I’m trying to find out if a webcast or transcript of the forum will be available. I’ll let you know what I learn.

12:26 p.m. The forum will not be available by webcast or transcript.

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AHS’s Annual Meeting Underway

The American Headache Society’s 47th annual scientific meeting began today. Press releases are now available for some of the key conference presentations. There’s some good stuff here!

2/9/10: These press releases are no longer available from AHS.