Is There Hope for the Headache?

Ahead of the Curve: Innovative Surgery in Annapolis

By Kymberly Taylor

 

 

You or someone you know has probably experienced a crippling headache—a throbbing pain begins on one side of the head. If it’s a migraine, light, sounds, smells and even people become irritating. Bright flashes (called aura) may appear. Pain tightens around your head like bands of steel. You leave work, go home, find a dark room and hide. You will try almost anything to make it stop.

Apparently, the Neanderthals felt the same way. Studies reveal that as early as 7,000 B.C. segments of bone from the skull were removed to treat head pain caused by demons trapped inside, according to Headache Australia and the Brain Foundation. The procedure, called trepanning, was still recommended by 17th-century physicians.

Today, over 12 million Americans suffer from migraines; 90 percent are unable to work or function normally, according to the Migraine Research Foundation. Treatments range from drugs, herbs, acupuncture, biofeedback and Botox to gluten-free diets and lifestyle changes. The quest for a cure continues.

However, there is hope at least for some people. A relatively new surgery, referred to as migraine surgery, nerve release therapy, or nerve decompression surgery, may cause your headaches to improve dramatically or even disappear.

Dr. Emily Clarke-Pearson, a plastic surgeon new to Annapolis working with the Sullivan Surgery and Spa, offers this specialty surgery. She explains that certain headaches can be triggered when tissues and blood vessels irritate a sensory nerve in the forehead or scalp and pin it down or “tether” it. This nerve irritation can trigger a headache attack.

During surgery, small incisions are made and muscle, blood vessels and scar tissue are dissected away to release the nerve. Following the surgery, approximately 85 percent of patients experience relief, notes Clarke-Pearson.

The outpatient procedure takes one to two hours and the patient will have a small scar hidden in the brow or in the hairline. Recovery time is minimal and low-dose pain medication prescribed.

The procedure is not for everybody, she cautions. Nerve release surgery is recommended by a neurologist when all else fails, and only for patients whose headaches improve with numbing injections or Botox. In fact, patients with chronic headaches after trauma or due to occipital neuralgia (irritation of nerves in the back of the neck) may experience the greatest benefit when compared to classic migraine headache patients.

The surgery is only about 16 years old and pioneered by Cleveland-based plastic surgeon Bahman Guyuron, M.D. He made the discovery incidentally while performing a forehead lift in 1999. He performed 314 forehead surgeries, routinely cutting into tissue and muscles. Thirty-nine of those patients happened to suffer from migraines. Thirty-one reported freedom from migraines after surgery.

Although Guyuron’s work has been widely publicized, it has not gained widespread acceptance. Following publication, the study was criticized for faulty methodology including inadequate blinding between patient groups. However, new studies, sponsored by the National Institute of Health, are underway.

Clarke-Pearson is well aware of this research as well as advancements in the technique. During her plastic surgery residency at Harvard and Massachusetts General Hospital’s Division of Plastic and Reconstructive Surgery, she trained with a mentor surgeon, one of the pioneers of Guyuron’s work. “It was a great experience. At the time I was learning what worked and what didn’t,” she recalls.

Serendipitously, during her training, she herself experienced painful migraines. “I was able to make lifestyle changes, but I know what it’s like. I can just picture myself in my bed blocking out all the light. To think of having one every day … I know professionals who have to stop working, or cut back on what they are doing.”

She stresses that no one is claiming that nerve release surgery is a cure for headaches and research is preliminary. However, she has seen firsthand how this procedure can make a big difference in the lives of the right patients.

“With a disability that great we have to keep turning over stones … it’s very promising,” she says. She has seen people whose lives have been ravaged by this complex disease and observed how joyful patients are after the procedure. It is good to know that hope is here and, however preliminary, real progress.

 

Resources

Emily Clarke-Pearson, M.D., Sullivan Surgery and Spa, ksullivanmd.com

Headache Australia, the Brain Foundation, headacheaustralia.org.au
Migraine Research Foundation, migraineresearchfoundation.org
National Institute of Neurological Disorders and Stroke, ninds.nih.gov

For more information on the National Institute of Health’s clinical trial see “Prospective, Multi-Center Evaluation of the Efficacy of Peripheral Trigger Decompression Surgery for Migraine Headaches,” clinicaltrials.gov/ct2/show/NCT02351544.