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Surgery for Migraine and Headache: Does it Work?

Nerve stimulation, nasal surgery/septum repair, cutting muscles in the forehead and PFO closure are the surgeries commonly mentioned as headache treatments. A lot of press coverage doesn’t necessarily equal efficacy. They are all still in early phases of clinical trials. Recent opinions I’ve come across aren’t encouraging.

I’ve had two of the four — an occipital nerve stimulator and nasal surgery — and don’t intend to try a surgical treatment again. Neither surgery was effective for me and I sometimes wonder if the nerve stimulator made my migraines worse.

Surgery is so commonplace that it is normal to consider it as a remedy for so many illnesses. No matter that general anesthesia is always risky and there’s a potential for complications — including that it may worsen the condition. Not to mention that its expensive and invasive and may not even work.

I’m not saying that because my surgeries were unsuccessful yours will be too. I do caution you to take it slowly. Research the procedure as much as you possibly can. Ask your doctor every question that you have, no matter how silly or small it may seem. This is your body. The doctor may have the expertise, but you are the only one who really knows yourself.

If you have the slightest inkling of discomfort with your doctor, find someone else. If he or she tells you in your first appointment that surgery is just the thing for you, find someone else.

Although surgery may feel like your last hope, it rarely is. Few people have truly tried everything. If multiple doctors say you’ve tried everything, it’s time to get on the internet and learn what else is out there. Online forums are a great place to start. (I’m partial to The Daily Headache’s online support group and forum, but there are lots of good ones.) Maybe you’ll discover that you have tried everything; maybe you’ll find a not-so-well-known treatment works for you.

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Closing Hole in Heart to Treat Migraine: PFO Closure Study Findings Not Promising

pfo closure migraine study

Studies linking migraine with a hole in one’s heart have been big news in recent years. Preliminary studies showed promise. Results from a large trial, MIST-I (Migraine Intervention With STARFlex Technology), are finally available — and they aren’t good. Researchers concluded that “no significant effect was found for primary or secondary end points.

Background
The hole, called a patent foramen ovale (or, more commonly, PFO), is an opening between the upper chambers of one’s heart. Some migraineurs who had PFOs closed for another reason reported that their migraine attacks stopped or were much less frequent after the surgery.

The hole is present in fetuses to allow blood to pass from one side to the other. In most people, the gap closes at or after birth. For an estimated 25% of the US population, it doesn’t close completely and the PFO forms. This remaining tunnel functions as a valve. Normally the valve is shut, but sometimes remains open, sending blood that’s supposed to go to the lungs off to the brain and other parts of the body.

MIST Study Findings
My head is too bad to give a good summary, so here’s what cardiologist and blogger Dr. Wes had to say:

This week’s Circulation (on-line version) released the much anticipated MIST trial (Migraine Intervention With STARFlex Technology) results which randomized 147 patients with a moderate to large PFOs between implantation of a STARFlex PFO closure device and a sham (or placebo) procedure.

The study’s primary efficacy end point was migraine headache cessation during the analysis phase. It was derived from diary data.

Secondary efficacy comparisons were incidence of migraine during the healing phase; change in the severity of migraine attacks based on MIDAS (over a 3-month retrospective period) and headache impact test (HIT-6) (over a 1-month retrospective period) scores; change in the frequency of migraine attacks other than elimination of attacks; change in the characteristics of migraine (with or without aura and change thereof); change in the severity, frequency, and character of migraine relative to effective closure rate or presence of residual leak; and change in quality of life based on the SF-36 questionnaire (over a 1-month retrospective period).

Dr. Wes notes that Peter Wilmshurst, one of the original main lead researchers is not included in the manuscript. At a conference last year, Wilmshurst claimed study data were not managed correctly.

Many PFO closure studies, like PREMIUM and ESCAPE are still happening. As is MIST-III, a longer-term trial with the same device as MIST-I. I’m not ready to dismiss PFO closure for migraine. This trial was a pretty big deal, but other study results are necessary. I guarantee I’m not letting anyone near my heart unless there’s strong evidence for doing so.

[via Kevin, MD]

Graphic from Cleveland Clinic’s PFO page.

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Headache NewsBlog By Headache Specialist Alexander Mauskop

Alexander Mauskop, director of the New York Headache Center, regularly posts his thoughts on current headache news on the aptly named Headache NewsBlog. He dispels myths and examines closely media coverage of headache news. Here’s a taste of Mauskop’s blog, but look over Headache NewsBlog to get the full flavor.

Current News

Medications

Botox

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This Time Last Year, March 11-17

Posts from The Daily Headache, March 11-17, 2006

Reporting on Narcotics & Headache: What a Mess
A look at an article in ABC’s three-part series on migraine that I was really upset by. Reviewing the article, I saw something that now makes a lot of sense to me:

“. . . Long-term use of narcotics can actually magnify headache pain and could render other treatments ineffective.

“‘Not only does it deplenish your own natural painkillers,’ he said, ‘but it destroys parts of the brain that are responsible for fighting pain.'”

The story clearly wasn’t as awful as my gut reaction indicated.

Preliminary Results for PFO Closure Trial
The MIST study examining whether closing a hole in the heart is an effective migraine treatment reported mixed results, depending on the journalist’s perspective.

ABC on Migraine: It Gets Worse
The final installment of the series looked at a nasal surgery that some are using to treat migraine. This same surgery was ineffective for me (and for many others, I have since learned), so I’m skeptical of it. The article’s author does describe unfavorable opinions of the surgery.

Toxicity of Tylenol
Acetaminophen is far from benign: Overdoses of products that contain acetaminophen account for 40 to 50% of all acute liver failure cases each year in the United States.

Healthcare Provider of the Year
The National Headache Foundation‘s call for entries for this award. I can’t find who won last year, but I did see that nominations were requested for this year — but were due yesterday. Sorry, it’s the first I heard about it.

Pill-Taking Woes Resolved
A handy dandy gadget for pill swallowing ease.

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Nerve Stimulator Heartbreak

Being helpless in the face of illness is like window shopping. You’re looking through the glass at all the possibilities for an effective treatment. Every time you start to walk through the door, thinking you’ve found what will provide relief, the metal grate slams down at your feet.

You can stick your fingers through the holes, but never far enough to touch what you need. Eventually there’s nothing left to reach for.

My choice to have a nerve stimulator implanted was made in desperation. I still believe that logic and reason were present, but having truly run out of options was a tremendous influence.

Desperation also allowed me to delude myself that the trial implant was effective — even though my husband and doctors didn’t think it was. It allowed me pay the outrageous cost of the surgery. And despair let me believe that the stimulator worked.

Now I know that even right after the implant, I didn’t really believe it worked. My sanity required me to think it did. For the eight weeks following the surgery, I was in hell. My last shot at relief didn’t appear to help. The rest of my life would be marred by excruciating pain. I had reached rock bottom and stayed there for nearly a year.

What got me out of bed was crediting the stimulator with making me more functional than before the surgery. Even with the doubt that crept in, earlier this year I trusted in the stimulator enough to tell you it relieved my pain. Now I know that it never helped at all.

As with many sorts of recovery, it took utter despair to accept my illness. I would do anything to spare you the agony of that year. But no matter what I say, your pain will drive you. Whether the treatment is meds, acupuncture or nerve stimulation is irrelevant.

I cringe when I’m asked my secret for being happy even with this misery. The answer is not wisdom that I can impart over coffee. You have to live it and will only know that you have when you’ve gotten to the other side.

What a discouraging post! Know that I’m one of the “special” few whose headaches are untreatable. Please don’t give up without exhausting your options. Once you think you’ve tried everything, ask about and research what other treatments or treatment combinations are available. You’ll be amazed by the possibilities.

If you’re thinking about getting a nerve stimulator, remember that I represent only one side of the story. While most of the people I know have similar experiences, people with good stories aren’t likely to seek out someone with a bad story. Do your research though. Whether the stimulator works for you or not, you’ll be grateful knowing it was a well-thought out choice.