More than 28 million people in this country suffer from chronic migraine headaches; about 80 percent of them are women. Until now most have tried to eliminate or cope with the often debilitating pain — and sometimes other symptoms including nausea, sensitivity to light, and a visual or sensory aura — by taking strong medication and trying alternative treatments. Now there’s new hope for migraine sufferers, thanks to a surgical procedure developed by Dr. Bahman Guyuron, a plastic surgeon at University Hospitals at Case Medical Center in Cleveland, Ohio. We talked with Dr. Adam H. Hamawy, a board-certified plastic surgeon affiliated with WESTMED Medical Group’s offices in Rye and Yonkers, who has performed this innovative surgery for the past three years.
How did Dr. Guyuron develop this procedure?
After performing forehead lifts, he found that many patients, who also had migraines, reported that a side effect was the disappearance of the migraines, or at least a decrease in their frequency or the pain level. He investigated the possibility that certain nerves encountered were relieved. Dozens of scientific papers subsequently were published, confirming his suspicions. A study published in Plastic and Reconstructive Surgery recently reported that 60 percent of patients said their migraines were much better five years after the surgery, and about one-third said surgery totally eliminated the migraines.
What patients are good candidates for this surgery?
I have some patients who’ve tried all medications and nothing’s worked, but also others who take medication that helps, but want to get off taking it regularly. We operate on both men and women, most in their early 20s to late 40s.
What’s the usual scenario before surgery?
Patients come to me after seeing their internist, family practitioner, or neurologist. I insist on an established migraine diagnosis. We want to be sure they’ve tried medications — and know what works for them and what doesn’t — before we try surgery.
Beside the diagnosis, what else do you ask in an initial consultation?
I want to know where anatomically they feel that the migraine starts. There are usually several possible trigger points — above the eyes, at the temple, behind the back of the head, or inside the nose and sinuses.
I ask them to keep a headache log for three to four weeks, so we can determine how many trigger points they may have, which affects the extent of the surgery. Once we identify a possible trigger point, we initially try to treat it with Botox. If that results in relief, the patient has a high chance of success with surgery. The Botox only helps relieve or remove pain for about three months. If it doesn’t help, it’s unlikely that surgery will succeed and we have avoided performing an unnecessary operation.
If surgery is required, where is it performed?
In an ambulatory surgical center or hospital. It’s an outpatient procedure that requires general anesthesia and can take from 90 minutes to five hours, depending on the number of trigger points being treated.
Are there any side effects?
Yes. Initially patients may have a headache from the surgery, but usually not a migraine. Some report a feeling of numbness or burning in the scalp; a rarer number cite a weakness on one side of their forehead from stretching of the facial nerve. If this happens, it’s usually temporary and recovers after several weeks. There are also scars, which are very small, about a half-inch long, and are hidden inside the hairline on the scalp. Most patients go back to work within a week.
How effective is the surgery?
About one-third of patients report they no longer have migraines. Others don’t have them as often — maybe a few times monthly rather than several times weekly — or they may not have as painful migraines, possibly a three-four on a scale of 10, rather than an eight-nine.
Do most insurance companies cover this surgery? And if not, how much does it cost?
So far most area carriers don’t cover it; for one trigger point, it might run $7,000; up to four might be $20,000. The number of migraines a patient has a month may influence the carrier’s decision.
What questions should a potential patient ask the physician before deciding whether to have the surgery?
What are the chances that the surgery will help me? How many of these surgeries have you done? You want someone who’s confident and has a high success rate at relieving migraines with the procedure.