Surgery for Migraine . . . and Other Hot Topics

Not a day goes by when at least 2-3 patients bring in new articles or simply comments from someone who claims they can cure migraine.  Yesterday someone asked me why we don’t just do acupuncture because “studies show it is 100% effective.”  If it were 100% effective then of course that is all we would do.  I recommend acupuncture to almost every patient . . . however, like anything else it works for some people but not for many others.  There has been a lot of research in acupuncture and it, on average, has modest improvement for about half the patients. That doesn’t mean that one now and then will have remarkable results and it is worth trying for everyone.

The hottest topic of the past year has been migraine surgery.  The people who do this surgery have been on several major news programs and they sometimes promote a near 100% cure rate (which should raise eyebrows for anyone).  There are serous concerns about both the fact of it, (does it really help), and the nature of it (being invasive and costly).

I attended an excellent debate last summer in Boston on the topic of the role in surgery to treat migraine. It was between the father of migraine surgery Dr. Bahman Guyuron and and one of his major opponents, Dr. Hans-Christoph Diener. Today the narrative about that debate was published and I wanted to share it here: ( 73. Surgery for Migraine – The Debate).

I advise patients to wait and see. About eight years ago having holes in the heart closed was the fad to help migraine. I know of reports on at least one migraine patient who died during the procedure.  Three years later, after intensive international studies, it was proven not to be helpful for migraine sufferers.  So, it is best to error on caution when you are talking about invasive and permanent procedures.

I heard that the Today Show was doing a program on a possible cure for migraine.  I wasn’t home to watch it but streamed it from the network. I was happy to see an old familiar face, no not Matt’s, but Dr. Joel Saper. He was my first boss and mentor. In his program they talked about occipital nerve blocks (which we do) and they actually did live on TV a facet block.  This is sometimes helpful for patients with significant neck involvement.  Certainly this is not a cure or a panacea and Dr. Saper would be the first to admit that.

Most of the things you read about in the media or see on TV (especially if it is an infomercial) are incorrect at best (a con at worst). I review shows such as Dr. Oz, The Doctors and etc. when they talk about headaches. They almost always they explain headaches from the same old paradigm from the 1960s or 1970s.  Most of the time, these are not good information sources for the migraine sufferer.