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Doctors performing surgery for migraines

September 9, 2008 12:00:00 AM PDT
If you suffer from migraines, chances are you've tried everything from medication to alternative therapies. Sometimes these things work, sometimes they don't. Now a handful of doctors say they know a way to "surgically" remove the cause of the headaches.Maria McIntyre works for a construction company. But the constant head pounding Maria suffered didn't come from work. It came from chronic migraines.

"Imagine having a level five or six of pain that doesn't go away. It is tiring," said McIntyre.

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

"It's very cool to help somebody who had pain for many years," said plastic surgeon, Dr. Ivan Ducic.

Dr. Ducic is one of only a few surgeons performing microsurgery for migraines.

He says in some patients a pinched nerve is causing the pain. In the procedure, he removes a small part of the muscle that's pressing on the nerve, which relieves the pain.

"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," said Dr. Ducic.

That 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 can not be paralyzed from them because they're only purely sensory nerves," said Dr. Ducic.

Eligible patients include those who have had migraines for six months, those seeing a headache specialist and feel tenderness in the back, side and front of the head. Two surgeries fixed Maria's problems.

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

Now she can concentrate on housing instead of headaches.

Microsurgery is an outpatient surgery that takes about an hour-and-a-half. patients usually feel complete relief in about three months. Side effects are rare and only a handful of people end up with infections.

Web Extra Information:

BACKGROUND:

Roughly 28 million people in the United States are victims of migraines and two-thirds of those who suffer from migraines are women. Migraines can be caused by a variety of factors. Hormonal changes, such as fluctuations in estrogen, appear to cause head pain.

For some people, certain foods may also activate a migraine. Alcohol, aged cheeses, chocolate, aspartame and caffeine are some of the main culprits. In addition, stress, sensory stimuli like bright lights, and changes in the environment can trigger a migraine. People often turn to pills for relief, but sometimes, the pain is only temporarily subsided. Now, a new microsurgery is providing an alternative, long-lasting treatment.

RELIEVING THE PRESSURE:

Migraines are sometimes a result of the constriction of nerves located in the head. Most of the time the occipital nerve is affected, resulting in occipital neuralgia, which is characterized by a piercing or throbbing pain felt in the upper neck, back of the head and behind the ears.

The occipital nerves run from the neck up through the back of the head to the scalp. Pressure may be put on the nerves from surrounding muscles and tissues or as a result of a trauma. The surgery decompresses the nerve by removing a small area of muscle that is surrounding and pinching it. The treatment works without compromising muscle function or by widening nerve tunnels. It takes about three months for patients to feel full relief. For those who still feel pain after the first surgery, a second surgery to remove the nerve completely is available. The surgery is safe, as only two out of every 400 patients get an infection. If a person suffers from a migraine every day or has to stop their daily routine because of migraines, he or she could be a candidate for surgery.

In order to be eligible for surgery, a person must have suffered from migraines for longer than six months. They must also be under the care of a neurologist or pain specialist, who has excluded any possible organic or metabolic causes of the conditioned and who has prescribed medical treatment regimens, such as medication. The person much also feel tenderness in the back, side, or front of their head.

Patients can test whether or not the surgery will work by pressing on the tender nerves and later having a physician inject numbing medication into the hurt area. If the patient responds to the medication with positive results, the specific nerve that is agitating headaches can be determined. Ivan Ducic, M.D., chief of peripheral nerve surgery at the Georgetown University Hospital, has been performing the surgery for about four years and is one of two physicians currently carrying out the surgery on a regular basis. He believes that as time goes on, more and more physicians will rely on microsurgery in order to cure migraines. "It's very cool to help someone who had pain for 20, 30, or 40 years and have a relatively simple procedure to help them go on with life," Dr. Ducic told Ivanhoe. "It's very rewarding."

 

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