Curious about nerve stimulation for chronic migraine and what the research has to say? For Nerve Stimulation Research, my latest post on Migraine.com, I pored over all the published research, hoping to summarize it neatly, but the findings are too ambiguous to do so. Instead, I explain some of the reasons why older published studies aren’t generalizable and summarize findings from recent large-scale studies with control groups.
I’ve never felt more like a guinea pig than I did when I had my occipital nerve stimulator implanted almost 10 years ago. Read about the experience, and my thoughts about it all these years later, in Migraine & “The Box” — Feeling Like a Guinea Pig With an Occipital Nerve Stimulator on Migraine.com.
The post is in response to the Migraine & Headache Awareness Month Blog Challenge question from June 12, What situation in your migraine/headache disorders treatment has made you feel most like a guinea pig or lab rat?
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)?
Every night since my headache specialist recommended I get tested for a patent foramen ovale (PFO), I have lain in bed at night visualizing my heart with a hole in it. As if imagining and hoping for this defect would make it so. I so desperately want to have this hole in my heart because many migraineurs have experienced a reduction in the frequency and severity of their migraines after having their PFOs closed. This exemplifies one of the strange ways chronic intractable migraine has changed my thinking: I want to need heart surgery because there is a chance that it might finally offer an effective treatment for the migraines.
Wondering what in the world a PFO is and how it relates to migraine? Here’s what I wrote about it in 2008:
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.
Are Migraines Linked to a Heart Defect? is a helpful Q & A in the New York Times from 2010. I can’t find any recent stories on it. What I understand from talking with my headache specialist is that PFO closure has been helpful for migraine with or without aura (most early reports focus only on migraine with aura) and — though I have a hard time believing I heard this correctly — 80% of migraineurs who have PFOs closed report some degree of migraine relief following the surgery.
My fingers are crossed until I get the test results tomorrow.
ClinicalTrials.gov is the place to go if you’ve considered participating in a clinical trial for your headache disorder, These are just the latest in 142 headache studies recruiting participants or will be recruiting soon.
Nearly every headache disorder is represented: cluster, tension-type, post-traumatic, migraine, cervicogenic, lumbar-puncture, medication overuse (rebound)…. Treatments range from medication and surgery to diet, coping skills training, relaxation, meditation, yoga, exercise… Again the list goes on.
The diverse collection of current studies include:
- Sumatriptan 4 mg Statdose in the Acute Treatment of Cluster Headache
Conditions: Episodic Cluster Headache; Chronic Cluster Headache
Intervention: Drug: Sumatriptan 4mg Statdose injection
- Rhinogenic Headache Improvement After Nasal Operation
Conditions: Rhinogenic Headache; Contact Point Headache
Interventions: Procedure: Septoplasty; Procedure: Septoplasty and endoscopic contact point correction
- Galantamine in the Treatment of Post-Traumatic Headache
Conditions: Post-Traumatic Headache; Head Trauma, Closed; Retention Disorders, Cognitive
Intervention: Drug: Galantamine
- A Randomized Trial to Optimize Discharge From the ED After Treatment for Headache
Conditions: Migraine; Tension-Type Headache; Primary Headache Disorder
Interventions: Drug: Sumatriptan 100mg; Drug: Naproxen
- Pediatric Headache Trial
Interventions: Behavioral: coping skills training; Behavioral: headache education; Drug: amitriptyline
Even if you’re not interested in any of these studies, checking the government’s clinical database regularly may turn up something new that works for you. Searching for “headache” gets the most results, but you can also search by specific headache type. For example, there are 74 active studies on migraine and seven on cluster headaches.