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article imageSurgical procedure could give relief to some migraine sufferers Special

By Jane Fazackarley     Mar 2, 2011 in Health
Figures from UK-based Migraine Action say that one in seven people in the United Kingdom suffer from migraines. The condition is said to cost the UK $17 billion a year.
Over-the-counter medications have become more readily available in recent years and Triptans are often used to try and help reduce symptoms but these aren't effective for everyone. Last year Botox was cleared in the UK for the treatment of severe migraines.
According to the Migraine Research Foundation, in the United States, 18% women and 6% of men suffer from migraines costing American employers $13b a annually and 113 work days are lost each year.
Recent studies have come up with a theory that some migraines can be caused by the compression of nerves in the head and neck. Now, some migraine sufferers could find relief from their symptoms with a new surgical procedure that works by reducing the nerve compression that could trigger them.
Dr. Ziv Peled trained at Harvard and is based in San Francisco. He is one of the few surgeons qualified to carry out the surgical technique.
In a press release Dr. Peled said:
"Patients report significantly fewer headaches, lower headache severity, and shorter headache duration in those who still report headaches at all."
In an email, Dr.Peled explained more about the technique and how it works:
"The surgical procedures involve decompressing (i.e. unpinching) nerves in various places within the head and neck region. Over the past few years, several studies have been performed to test a recent theory that migraines are caused by nerve compression: Nerves in the neck, temples or forehead that are pinched as they pass through various anatomic structures or canals. As a result, the severe and recurring pain that some people experience is similar in origin to carpal tunnel syndrome, a commonly diagnosed condition for which surgical decompression is frequently performed. This surgical method has now been adapted for headaches caused by neuralgia, or trapped nerves."
Which type of migraine patients would this be suitable for?
"The patients who are candidates for surgery are those that have ruled out for other potential causes of headaches (e.g. brain tumor, aneurysm), have failed conservative treatments with medication (usually several classes of meds), have a history and physical examination that demonstrates evidence for a pinched nerve, and have a positive response to a Botox injection."
"It has to be a focal Botox injection. In other words, I have seen many patients from neurologists who have had unsuccessful results with Botox injections, but when you ask them how many injections they had and how they were performed, it seems as if the Botox was injected like shotgun pellets fly out of the weapon - a little here, a little there. If you give enough Botox, you'll relax anything, but this gets expensive, potentially dangerous and doesn't tell you anything about the underlying pathology. In other words, you can treat the pain of appendicitis with tons of morphine, but if you don't take out the appendix, you're missing the point."
"In my practice, you (typically) only need to inject 1-2 sites to see a result and these sites correspond to known anatomic sites of nerve compression by muscles. If you don't know where these are, you don't know what you're doing. These are just my practices and opinions, but they essentially mirror those of others.In my hands, if the patient meets these criteria, they are candidates for surgery since they are likely to have a good outcome."
How many patients have undergone this type of procedure?
"The largest study of such patients had about 200 patients in it. 80% of the patients who underwent surgery had 50% or greater relief from their migraine pain and over 43% had complete relief! That study was published in 2009. By now, surely many more patients have undergone this operation."
How widely available is this?
"Unfortunately, this operation is not widely available. The reasons for this state of affairs are likely multifactorial. One reason is that not just anyone should be doing this type of work as they are not specifically trained to do so. I myself completed four years of general surgery training at the University of Connecticut. While there I also completed an additional two-year basic science research fellowship at both Stanford University and New York University and during that time was awarded a $1.25 million NIH grant to study keloid biology and wound healing."
"I then completed my plastic surgery training at Harvard followed by another year of surgical training focusing specifically on peripheral nerve surgery. The leaders in this field are plastic surgeons, but since nerves aren't considered "sexy", most plastic surgeons don't bother with them. Therefore, most plastic surgeons (not to mention other types of surgeons)really have no experience with microsurgery not to mention any experience with manipulating peripheral nerves themselves. Those surgeons who have little experience with peripheral nerve surgery are right to stay away and refer patients elsewhere."
Migraine Action offer support and advice to sufferers. There is more information about their work here.
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