We still don’t know what fundamentally causes migraines, and most are considered incurable. But for a small number of sufferers, surgery can make severe, chronic migraines disappear forever.
This is as close as modern medicine has yet come to a cure, and it’s thanks to an Ohio-based plastic surgeon, Dr. Bahaman Guyuron.
Like the discovery of penicillin, Guyuron’s discovery that surgery could help migraines was a fortuitous medical accident—although this one was a side-effect of otherwise successful surgeries, not the result of lax housekeeping and moldy petri dishes.
After undergoing forehead lifts, some of Guyuron’s patients reported that their migraines disappeared. These reports intrigued Guyuron, who started studying the phenomenon and in 2000 started performing nerve decompression or deactivation surgeries to relieve migraines.
Nerve Decompression
The surgery is based on the theory that migraines can arise when branches of the largest cranial nerve—the trigeminal nerve—have pressure put on them and become inflamed.
Pressure on nerve branches can come from arteries that get looped around them, tumors that press against them, or when muscles and connective tissue called fascia become tense and restrict them. This impingement causes the nerve to become inflamed.
In surgery, a plastic surgeon will unloop the arteries, remove the tumors, or decompress muscles and fascia, relieving the immediate source of the pain.
Plastic and reconstructive surgeon, Dr. Kaveh Alizadeh, who studied with Guyuron and is the chief of plastic surgery at the Westchester Medical Center and surgical director and co-founder of New York Migraine Associates (NYMA), said that about 60 percent of surgery patients are able to quit all prescription medications afterward, and 90 percent see significant improvement.
Pioneering the Field
Migraine surgery is still experimental and continues to have some skeptics because it is more invasive than any other migraine treatments.
But as studies first by Guyuron himself and then others by medical institutions around the country have begun to turn up long-lasting positive results, the treatment has become more widely accepted, according to Dr. Elena Ocher, the executive director of NYMA and a pioneer in the field of surgical migraine treatment. NYMA is a center dedicated to finding a cure for migraines by utilizing medical and surgical techniques.
As to whether surgery is more effective than drugs, that depends on the patient, Ocher said.
“The truth is somewhere in between. Some you treat with medications, some you treat with surgery,” she said.
Ocher estimates that only about 10 to 12 percent of the headache patients she sees as part of her pain management practice are eligible for this surgery.
There can be many causes of migraine pain, and thus correct diagnosis is very, very important before considering surgery, she said.