New surgery could heal migraines

October 3, 2008 1:58:19 PM PDT
Chronic headaches can be life altering.But now a new surgery is providing some freedom from pain. It may even work to end migraines.

Imagine waking up every morning with a splitting headache and then trying to get through the rest of the day in constant pain.

Twenty-eight million Americans suffer from severe headaches and most of them are told medication is the only treatment.

But some doctors are performing a new kind of surgery that could heal the headaches for good.

Maria McIntyre works in the building industry. But the constant pounding that nagged her for years didn't come from work. It came from her chronic migraines.

"You wonder what is it that would give you a permanent state of pain like this that doesn't go away," McIntyre said.

McIntyre was taking a pile of pills that only eased the pain temporarily. Then she found a doctor with a permanent solution.

Doctor Ivan Ducic from Georgetown University Hospital is one of only a few surgeons performing microsurgery for migraines. He says sometimes a pinched nerve in the head is to blame. In the procedure, he removes a small part of the muscle that's pressing on the nerve.

"The nerve theoretically, after it's been decompressed, should regenerate and clinically then respond to no headaches or at least diminished headaches after the surgery," Ducic said.

He claims it works for about 80 percent of people. The others can have a second surgery to remove the nerve completely.

"These nerves have nothing to do with the function of your brain, arms, legs; you cannot be paralyzed from them because they're only purely sensory nerves," Ducic said.

Rush pain specialist doctor Sandeep Amin is familiar with the concept of nerves and their possible link to headaches. He does another approach known as "peripheral nerve stimulation." Microsurgery is used to relieve pressure on a nerve; stimulation is designed to alter the transmission of a nerve.

"Trying to change the way the signal is transmitted when a patient gets a migraine headache. So you are trying to send a signal back deeper to the patient's brain," said Amin.

An implanted device stimulates nerve fibers to block the sensation of pain. The idea is to turn off a part of the brain that causes a migraine to begin. Amin says the tricky part is identifying which patients are the best candidates. He does not do the microsurgery and questions whether it can fix a true migraine but says in the right patient it could bring headache relief.

"There is no imaging study," Amin said. "Be it in the form of MRI or CT scan, which will show, here is the nerve being compressed under a bundle of muscles. So the only way to tell is when you go in take a look and see if that's the case."

Microsurgery candidates must have migraines for at least six months, should already be seeing a headache specialist and complaining of no relief from conventional treatments. They should also be experiencing tenderness in the back, side and front of the head.

Two surgeries fixed McIntyre's problems.

"I'm a much friendlier person. I'm much easier to work with," she said.

Microsurgery does not mean this is a small procedure. It does require general anesthesia and is invasive. It can take anywhere from one to two hours to perform. There are only a handful of surgeons in the country currently doing this, but Ducic predicts the surgery will start catching on as more physicians learn about it.

Extra links:

Dr. Ivan Ducic
Georgetown University Hospital
Division of Plastic Surgery
202-444-8751
www.georgetownuniversityhospital.org

Occipital Nerve Stimulation
Dr. Sandeep Amin
Rush University Medical Center
312-942-5000
www.rush.edu


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