A Life Changed by Migraine Surgery

Cosmetic surgery leads to possible pain relief from migraines

July 23, 2015 by Alison Bowen, Chicago Tribune

Bryan Kirsch knew something was wrong when the stairs moved. After roughhousing with his children in 2011, he was walking upstairs with one when, he remembered, “I look up the stairs, and the whole world is spinning.”

Thus began three years of near-constant pain from migraines. Kirsch is one of the first people in Chicago to undergo a surgery aiming to alleviate chronic migraine pain. Now, Kirsch says, he is essentially free of pain. “I couldn’t have sat out here,” he said as an elevated train rumbled and roared overhead. “It’s been night and day for me.”

Cleveland plastic surgeon Bahman Guyuron, who has trained about 50 doctors across the nation to perform this surgery, said he discovered a correlation by chance in 1999. He noticed that, among his patients, people with cosmetic forehead lifts also noted migraines ebbing.

“I thought that that was just a coincidence,” said Guyuron, emeritus professor of plastic surgery at Case Western Reserve University School of Medicine. “A couple of weeks later, another patient told me the same thing.”
Some doctors say certain types of chronic migraine headaches can be caused by nerve compression. Surgery can release the pressure on the nerve from surrounding tissue like muscle, which can then alleviate pain.

After nearly two decades and 24 studies by Guyuron’s team, doctors are working to get health insurance companies to recognize and cover the surgery – as well as build awareness about a procedure they say can alleviate debilitating head pain.
Guyuron says studies show as much as a 92 percent success rate. A 2011 article in the Journal of the American Society of Plastic Surgeons tracked patients five years after undergoing the surgery. It showed 61 of 69 patients reported improvement, and 29 percent reported a complete elimination of migraines.

Dr. Elizabeth Loder, chief of the Division of Headache and Pain at Brigham and Women’s Hospital in Boston, said migraines naturally wax and wane, making it difficult to tell whether change is due to a solution or simply time.

Loder is former president of the American Headache Society, which in 2013 cautioned against this type of surgery outside of a clinical trial.

Clinical trials are strictly controlled, and Loder said data with long-term follow-ups and a randomized, larger number of patients would amp up the research base.
So far, the database does not include as many patients as Loder would like, and she said it could benefit from measuring people who did and did not receive surgery. Also, the different pain locations make it difficult to equally study patients, she said.

“I think we do need additional trials, ideally done by people who are not invested in the outcomes,” she said. “It would certainly be interesting to see the results of these trials. No one is saying this shouldn’t be investigated further.”
Not everyone is a candidate, doctors who perform the surgery say. Typically, it can most help those with chronic pain, suffering about eight to 15 headaches a month not helped by medication.

Northwestern Memorial Hospital plastic surgeon Dr. Mohammed Alghoul has performed the surgery on four patients in Chicago so far; all of them saw a neurologist first. About 1,100 patients nationally have had the procedure, according to Guyuron’s office.

“(Patients) will tell you the pain is there all the time; it doesn’t really go away,” Alghoul said of surgical patients before their procedures. “It may be a 2, 3 out of 10 (on the pain scale), but there’s always pain happening” even when they aren’t having a typical migraine.
Doctors identify four different places, called trigger sites, on the head where this might occur: the forehead, temple, nose and back of the head. This surgery has been adapted to all the sites.

Patients get local or general anesthesia, depending where on the head the surgery is, and they generally spend about half a day in an outpatient surgery facility, according to Guyuron
The procedure involves making small incisions, then releasing nerve pressure.
Kirsch, 37, left the hospital the same day.

“The rest of my life’s back to normal,” he said. “Relief was almost instantaneous.”
The father of three still remembers exact dates of appointments and the day he first felt dizzy. He recounts a laundry list of answers sought – from a neurologist; neurosurgeon; neuro-ophthalmologist; an ear, nose and throat specialist – and about 10 different prescription medications he tried.

“I pretty much had tried every specialist under the sun,” he said. “Nothing was helping.”
He missed his kids’ birthday parties and his sister’s wedding reception because noise triggered pain. He was scared that he would have a dizzy spell while driving his children, so his wife took on chauffeuring duties. Sometimes, at home and at his office as an attorney, he’d have to just sit in a dark room, separated from the world.

Finally, a neurologist at Northwestern suggested he meet Alghoul, who had just learned the procedure from Guyuron in Cleveland.

He was a bit concerned about surgery, he said, but felt comfortable with the explained risks, which can include infection, bleeding and numbness.
“At this point I’m like, ‘I’ll try anything and anybody,'” Kirsch said.
To see if he was a good candidate, Alghoul first administered Botox, which can weaken muscles and nerves. After that procedure, Kirsch said, he was pain-free for the first time in years. After the Botox helped, doctors said that was a sign he would be a good candidate to go through with the surgery.
The doctors hope more health insurance companies will cover the surgery. The cost can be about $3,000 to $4,000 per surgery site; patients often have multiple trigger sites. In June, Alghoul met with representatives from Blue Cross and Blue Shield, he said, presenting research in an effort to convince them that the surgery is past the experimental stage.
Kirsch’s surgery was not covered by health insurance. Although the cost was not small, he said it was a no-brainer if it meant being present at his kids’ birthday parties.
“My wife and I never even debated,” he said.
These days, Kirsch still takes earplugs to hockey games but said he does not experience migraines. He gets occasional headaches in the same spot, but he said it’s no different from what most people occasionally endure.
On his way to a baseball game after the surgery, a broken stitch left his still-numb head bleeding. But after years of not being able to enjoy loud stadiums, he simply found the first-aid station – and a bandage – and watched the game.

“My wife said, ‘It’s almost like having you back again,'” he said.


Migraines: Can Dementia, Stroke, or Heart Attack Be Next?

July 15, 2013

Content provided by the Faculty of the Harvard Medical School
New Harvard research confirms some links, rejects others.

Two new studies from Harvard examine the possible associations between migraine headaches and other conditions. One study offers encouraging news: the headaches will not hurt thinking skills. Another study suggests a warning: the headaches, when accompanied by aura, may signal an increased risk of heart attacks and stroke. “After high blood pressure, migraine with aura was the second strongest single contributor to the risk of heart attacks and strokes,” says study author Dr. Tobias Kurth, adjunct associate professor of epidemiology at the Harvard School of Public Health. “It was followed by diabetes, family history, smoking, and obesity.”


A migraine is a throbbing headache that begins mainly on one side of the head, often accompanied by nausea. It can last from four to 72 hours, and it can be made worse by loud noise and bright light. Sometimes people who get migraines see pulsating lights or black spots or have blurry, distorted vision shortly before the headache kicks in. That’s called migraine with aura.
While we don’t completely understand what causes migraines, we do know that they are associated with an increase in tiny or “silent” brain lesions, which can be a risk factor for dementia and cognitive decline. “This led us to question if migraine headache is a progressive brain disease,” says Dr. Pamela Rist, lead author of one study and a research fellow at the Harvard School of Public Health. But after analyzing data on more than 6,300 women, Dr. Rist and her team determined that migraines, with or without aura, do not appear to lead to cognitive decline. They published their research recently in BMJ. “It is reassuring news for people with migraines,” says Dr. Rist.


The other Harvard study, presented at the American Academy of Neurology meeting in March, focused on more than 27,000 women, of whom 1,400 had migraine with aura (MA). Researchers found that MA was a strong contributor to the risk of developing major cardiovascular events such as heart attack or stroke.

While the study does not prove that MA is causing vascular events, Dr. Kurth says MA is a warning sign. “It should be considered a factor that could indicate increased risk of cardiovascular disease.” There is currently no evidence that treating or preventing migraine reduces future risks of heart attack and stroke.


Just because you have MA, it doesn’t mean you’ll have a heart attack or stroke. If you’re concerned about your risk, you can reduce it the same way everyone can: by controlling blood pressure, quitting smoking, exercising, and maintaining a healthy weight.

If you do have migraines and cardiovascular disease, be sure to talk to your doctor about which drugs you can use to stop migraine attacks. Dr. Kurth says some drugs used to treat migraine can cause blood vessels to contract, which may restrict blood flow and cause complications for people with existing heart disease or a high risk of stroke. The drugs include triptans, such as sumatriptan (Imitrex), almotriptan (Axert), and frovatriptan (Frova), as well as ergotamines, such as dihydroergotamine (DHE-45) and ergotamine tartrate plus caffeine (Cafergot).

Last Annual Review Date: May 1, 2013 Copyright: Copyright 2013 Harvard Health Publications

Botox for Chronic Migraines

July 15, 2013

Content provided by the Faculty of the Harvard Medical School
Excerpted from a Harvard Special Health Report

Botulism is a rare but serious paralytic illness caused by a nerve toxin produced by the bacterium Clostridium botulinum. People usually contract botulism after eating food contaminated with the toxin, which binds to nerve endings, essentially paralyzing motor nerves.

Yet the toxin is better known as a wrinkle-buster, since injecting tiny amounts above the eyes and over the bridge of the nose relaxes small areas of muscles, smoothing crow’s feet and frown lines. But onabotulinumtoxinA Injection (Botulinum Toxin Type A, Botox) has more than just cosmetic applications — it’s also approved for the treatment of cross-eye, abnormal squinting and eyelid twitching, neck and shoulder muscle spasms, and severe sweating.

In the mid-1990s, a number of anecdotal reports suggested people who got Botox injections to fight wrinkles also had fewer migraine headaches, spurring a flurry of clinical trials to test that idea. But the results have been disappointing. A review of 11 clinical trials concluded that Botox was “probably ineffective” as a treatment for episodic migraine and chronic tension headache.

However, Botox may benefit people with chronic migraine, a form of chronic daily headache in which people have headaches at least 15 days per month, at least eight of which are migraine. About 2% of adults are plagued by this crippling condition, which leaves many unable to hold down a job, do housework, or have any semblance of a normal social life.

In a two-part clinical trial, nearly 1,400 people received up to five courses of Botox into specific head, neck, and shoulder muscles every 12 weeks. After 24 weeks, people treated with Botox had fewer days with a migraine than those who received placebo injections. During the second phase, all participants received Botox for an additional 32 weeks. At the end of the study, nearly 70% of patients treated with Botox had at least half as many days with migraine. The most common side effects (neck pain and muscle weakness) were mild and short-lived, according to the study, which was published in the journal Headache in 2010 — the same year Botox was approved to treat chronic migraine in the United States.

If you are a potential candidate for this therapy, be sure to find a physician with experience doing the injections. According to headache experts, doctors require extensive training to properly administer the required 31 injections in seven different locations on the head and neck.

Last Annual Review Date: Jan 1, 2011 Copyright: Copyright Harvard Health Publications

Common Migraine Triggers

So you know your migraine triggers?

Trigger identification and management is an integral part of Migraine management. Some triggers can be avoidable, allowing us to avoid some Migraines. Other triggers can’t be avoided, but knowing that we have those triggers is still helpful in our efforts to have fewer Migraines. Another consideration is that triggers can be “stackable” or “cumulative.” This means that some triggers might not bring on a Migraine if we counter just one, but “stack” two or more together, and they bring on a Migraine.

Read the entire article here…

12 Tips for Living Well with Migraines

Do you know what your Migraine triggers are? Trigger identification and management are a vital part of Migraine disease management. If certain foods are triggers for you, you can avoid them. If messed up sleep patterns or missed meals are triggers for you, you can do something about them.

  • Evaluate your medical team
  • Review your treatment regimen
  • Identify those triggers
  • Plan better nutrition
  • Don’t forget good hydration
  • Find and adopt an acceptable level of activity
  • Improve your organization
  • Learn to delegate
  • Dump the guilt
  • Take some “Me Time” each day
  • Seek and offer support
  • Remember, you can be in control

Read More…