Migraine Surgery: What it is and how it is done
Ranked as the second leading cause of disability worldwide, migraines can be stopped with a surgical procedure. This is what a recent study published in July in the journal An international journal of surgical reconstruction. According to the scientific work, which followed 93 patients who underwent the procedure for more than 12 months, a total of 79 (84.9%) patients experienced a reduction of at least 50% of migraines.
“In addition, this study showed that 14% of patients reported complete elimination of migraines. Other works have increased even greater numbers, with up to 40% of patients experiencing complete elimination of migraines. As for the last work , they found a significant difference before and after surgery in the migraine disability assessment score, headache index, frequency, duration and intensity of pain “, explained the plastic surgeon. Paul Rubezmember of the Migraine Surgery Society (USA) and professional who brought the procedure to Brazil.
The doctor is the creator of the Migraine Surgery Academy, which teaches and encourages plastic surgeons around the world to perform migraine surgery in order to benefit more patients with the treatment.
Three decades of suffering from migraines
Businesswoman Rosinete Cione da Silva Rodrigues, 54 years old, faced frequent and severe attacks of migraine with aura for 33 years, when there are changes in vision, seeing white dots, flashes of light, bright dots and other changes, followed by a pain. head strong and steady.
“They have been with me since I was 17 years old. I underwent all kinds of treatment and I used medicine every day, even though I had many seizures”, says Rosinete, who underwent migraine surgery 4 years ago. had the procedure done on November 20, 2019. The improvement was 100% thanks to God and Dr. Paolo, who gave my life back. I began to ‘wean’ myself off the medication and today, thank God, I am no longer taking medication for migraines; I have a pain-free and drug-free life.”
Migraine and anatomical abnormalities
The study aimed to monitor the long-term results of patients undergoing migraine surgery and determine the relationship between pain and anatomical abnormalities. The work was a prospective review of 93 patients who underwent surgery for migraine between 2017 and 2021 with at least 12 months of follow-up.
“This study showed that the surgical treatment is effective and the result is maintained in the long term, with mild complications that are easily tolerated by the patient”, says the doctor.
Since it was created and developed, in 2000, by the plastic surgeon Bahman Guyuron, in Cleveland, USA, Migraine Surgery has been studied, quantitatively and qualitatively, year after year by several specialists around the world.
In June 2021, a Harvard Medical School study published in Plastic and Reconstructive Surgery concluded that migraine surgery is associated with improvement in headache symptoms and also a significant reduction in medication use, with data very close to the recent study.
“The 2021 study compared the use of drugs in the pre- and post-operative period of patients who underwent the procedure and found that more than 2/3 of them reduced the use of prescribed drugs, and 23% of the total number of patients who underwent the procedure a. they no longer need to take any medication,” explains plastic surgeon Paolo Rubez.
In the survey, 96% of patients described taking prescription medications for their headaches. After 12 months of the operation, 68% of the patients reported a decrease in the use of prescribed medications. “Patients reported a 67% reduction in the number of days they took their medication; in addition, half of the patients reported that the migraine medicine, after surgery, helped them more compared to the preoperative period “, emphasizes the doctor.
Complication rate is very low
According to a systematic review, published in February 2022 in Annals Of Surgery with an analysis of 68 studies, the results are satisfactory and favor the safety of the procedure, with a very low rate of complications and a high degree of patient satisfaction.
“Several studies support surgery which, when the pain does not stop definitively, is responsible for reducing the use of medication and improving the intensity of the pain”, explains the plastic surgeon. “Despite the availability of conservative treatment options such as medication, patients suffer from resistant migraine associated with a positive quality of life. Migraine surgery, which promotes peripheral nerve decompression, is a relatively new treatment strategy, but has a lot of scientific support for resistant migraine.
Qualitative analyzes have also been published. In 2019, an article published in Plastic and Reconstructive Surgery, a publication of the American Society of Plastic Surgeons, showed that migraine surgery has a positive impact on patients’ lives.
“Patients in the study reported benefiting from surgery in ways that are not currently captured in quantitative measures. Some patients even stated, in interviews, that after surgery they felt like a ‘normal person again’, in view of the improvement of one or various areas of pain after surgery and changes in medication use and effectiveness”, says Paolo.
How the procedure works
Migraine surgery is safe and effective by surgically decompressing peripheral nerves in the face, head and neck to relieve migraine symptoms.
“The operation is minimally invasive and aims to decompress and release the branches of the trigeminal and occipital nerves involved in the pain points. The peripheral branches of these nerves, which are responsible for sensitivity in the face, neck and scalp, can suffer compression of surrounding structures, such as muscles, vessels, bones and membranes. This generates the release of substances (neurotoxins) that trigger a cascade of events responsible for inflammation of the nerves and membranes around the brain, which will cause symptoms of intense pain, nausea , vomiting and sensitivity to light and sound “, says the doctor. .
7 main types of operation
Migraine surgery can be of seven main types in the following regions: Frontal, Rhinogenic, temporal and occipital (neck). According to Paolo Rubez, for each type of pain there is a different access to treat the branches of the nerves, all of them in the superficial areas of the face or scalp, or even in the nasal cavity. The doctor explained that each operation was developed to generate the smallest possible change in the local physiology.
“In all these types, the principle is the same: decompression and release the branches of the trigeminal or occipital nerves, which make them irritated by adjacent structures along their path.”
Surgery can be performed on any patient diagnosed with Migraine (Migraine) by a neurologist, and suffering from two or more severe pain attacks per month that cannot be controlled by medication; or in patients who suffer from side effects of pain medications or are intolerant to them; or even in patients who want to undergo the procedure because of the severe disability that pain causes in their personal and professional lives.
Finally, Paolo Rubez emphasizes that the operations are performed in a hospital setting and under general anesthesia and in some cases under local anesthesia. “The duration of the operation, for each nerve, is approximately one to two hours, and the patient is discharged home the same day”, he concludes.
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