Microsurgery could end your migraines

SEATTLE – Some doctors are performing a new kind of surgery that could heal migraine headaches for good.

Maria McIntyre works for a company that trains construction workers, but the constant pounding that nagged Maria for years didn’t come from work, it came from her chronic migraines.

Pills only helped a little. Then she found a doctor with a permanent solution.

"It's very cool to help somebody who had pain for 20 or 30 or 40 or 50 years," said Georgetown University plastic surgeon Dr. Ivan Ducic. He is one of the few surgeons performing microsurgery for migraines.

He says sometimes a pinched nerve in the head is to blame. What he does is remove a small part of the muscle that is pressing on that nerve.

"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 Ducic.

That works for about 80 percent of people. For others, a second surgery will 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 Ducic.

Those eligible for the surgery have suffered from migraines for at least six months are seeing a headache specialist and feel tenderness in the back, side and front of the head.

Microsurgery is an outpatient surgery that takes about 90 minutes. Patients usually feel complete relief in about three months.

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Migraine Definition

A migraine can be disabling — with symptoms so severe, all you can think about is finding a dark, quiet place to lie down. Up to 17 percent of women and 6 percent of men have experienced a migraine.

In some cases, these painful headaches are preceded or accompanied by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. A migraine is also often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days.

Fortunately, management of migraine pain has improved dramatically in the last decade. If you've seen a doctor in the past and had no success, it's time to make another appointment. Although there's still no cure, medications can help reduce the frequency of migraine and stop the pain once it has started. The right medicines combined with self-help remedies and changes in lifestyle may make a tremendous difference for you.

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Migraine Causes

Although much about headaches still isn't understood, some researchers think migraines may be caused by functional changes in the trigeminal nerve system, a major pain pathway in your nervous system, and by imbalances in brain chemicals, including serotonin, which plays a regulatory role for pain messages going through this pathway.

During a headache, serotonin levels drop. Researchers believe this causes the trigeminal nerve to release substances called neuropeptides, which travel to your brain's outer covering (meninges). There they cause blood vessels to become dilated and inflamed. The result is headache pain.

Migraine triggers
Whatever the exact mechanism of headaches, a number of things may trigger them. Common migraine triggers include:

Hormonal changes. Although the exact relationship between hormones and headaches isn't clear, fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, and this corresponds to a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications, such as contraceptives and hormone replacement therapy, also may worsen migraines.

Foods. Certain foods appear to trigger headaches in some people. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; fermented, pickled or marinated foods; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; certain seasonings; and many canned and processed foods. Skipping meals or fasting also can trigger migraines.

Stress. A hard week at work followed by relaxation may lead to a weekend migraine. Stress at work or home also can instigate migraines.


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Treatments and drugs

A variety of drugs have been specifically designed to treat migraines. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:

• Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
• Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.

Choosing a strategy to manage your migraines depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions. You may be a candidate for preventive therapy if you have two or more debilitating attacks a month, if you use pain-relieving medications more than twice a week, if pain-relieving medications aren't helping, or if your migraine signs and symptoms include a prolonged aura or numbness and impaired movement on one side of your body.

Some medications aren't recommended if you're pregnant or breast-feeding. Some aren't used for children. Your doctor can help find the right medication for you.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. It may help if you rest or sleep in a dark room after taking them:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil) or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines, but aren't effective alone for severe migraines. If over-the-counter medications don't help, your doctor may suggest a stronger, prescription-only version of the same drug. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches.

Other MEdications to treat the Migraine:

• Imitrex
• Flunarizine
• Maxalt

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