By Lisa J. Gotto
Migraines. If you get them or know someone who does, you know how painfully frustrating and disrupting they can be. Adding to the difficulty of experiencing them, the medical community has always been challenged to define and treat them. Why?
“Everyone’s migraine story is different,” says Dr. Emily Clarke-Pearson, a plastic and reconstructive surgeon, at Sullivan Surgery and Spa in Annapolis. And learning the “story” Clarke-Pearson says, is really the key to establishing the way forward for the patient when it comes to customizing a treatment plan.
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The term “migraine” is often used as a catchall for many types of chronic headaches.
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What we DO know
The first thing to do if you think you are experiencing migraines is see a neurologist. We do know that migraines as an inherent condition happen when an event triggers the central nervous system and angry nerves can result in painful, recurring headaches. The onset of an event is triggered either hormonally or by something in the environment, a sensory cue, such as an extreme light sensitivity or even a particular smell. (The hormonal aspect is most often seen in women, although men and even children also suffer from migraines.)
There are two other types of extreme headaches that we will also discuss because of their similarities to and often confusion with migraines. One is post-traumatic headaches, or PTH, caused by a traumatic event such as a sports injury or auto accident.
“For patients with chronic headaches after head trauma, it is possible that peripheral nerves injured in the accident get stuck in scar tissue or regrow abnormally, forming tender and disorganized bundles of nerve fibers called neuromas,” Clarke-Pearson says.
The other is a condition, called occipital neuralgia, occurring when superficial or peripheral nerves that run from the base of the spinal cord up through the scalp become inflamed or injured.
If you are suffering from the pain of any of these conditions it is easy to think they are all migraines. That is why it is important to see a neurologist to pin down exactly what you have so the right treatment path can be followed. In other words, a person who suffers from occipital neuralgia may not respond positively to the same treatment given a migraine sufferer.
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It is estimated that more than 30 million Americans suffer from migraine headaches approximately 18% are women and 6% are men
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Once a clear diagnosis is reached each of these types of chronic headaches can be treated and managed using a range of modalities. For the migraine associated with sensory triggers the first line of defense is a level of self-care that includes avoidance of triggers whenever possible, stress management, improving sleep habits, and making diet modifications. Physical therapies such as progressive muscle relaxation and acupuncture may also be added.
If headaches remain severe and debilitating, drug therapies that include analgesics, nonsteroidal anti-inflammatory drugs, nerve pain medication, serotonin receptor agonists, like Triptans, and Neurotoxins that relieve pain by reducing or eliminating muscle activity and spasms by paralyzing the muscles, can also be employed. (It’s important to note that the medical community does not recommend employing narcotics for pain relief in these cases because, at best, narcotics offer only short-term relief and the risk of dependency and addiction is too high.)
Some of the above drug therapies, such as anti-inflammatory drugs and Triptans, are being used early on in the treatment of PTH. However, if these trauma-induced headaches persist and remain moderate to severe in nature, preventative measures like antidepressants, blood pressure pills, and anti-seizure medicines may be recommended.
In occipital neuralgia cases, if massage therapy, hot compresses, rest, and anti-inflammatories, like ibuprofen are not working, your physician may prescribe a muscle relaxant, anti-depressant, or anti-seizure medication. Another course of action may include nerve blocks and steroid shots.
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Migraine is more prevalent than diabetes, epilepsy, and asthma combined.
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Help from a surprising source
Clearly, this is where your headache history or “migraine story” comes into play. For individuals whose stories seem like an endless book of chapters without happy endings, Clarke-Pearson says there is new hope in a surgical procedure that has been shown to provide relief for those who are just not getting it from other measures.
About a decade ago, a plastic surgeon performing a cosmetic “forehead lift” procedure noted that patients who also experienced migraine headaches reported a unique side effect: the cessation of their migraines, Clarke-Pearson explains.
“Since this incidental finding, doctors explored new theories that migraines and chronic headaches may be caused by nerves in the forehead on the back of the scalp, that when irritated or traumatized, send messages to the ain that trigger headache episodes.”
Clarke-Pearson, a Harvard trained plastic surgeon, has been performing nerve release surgeries for about three years, says while the proposition of surgery on the head may seem extreme or overwhelming, it is actually a simple, low-risk, out-patient surgery.
“It is performed through small incisions hidden in the eyelid or hairline,” explains Clarke-Pearson. “Post-operative pain is minimal, and is easily controlled with low-dose pain medication. Unfortunately, however, only a small number of plastic and neurosurgeons perform this procedure,” she adds.
The stats so far have Clarke-Pearson feeling pragmatically optimistic, especially when you consider the debilitating, ongoing nature of this affliction.
“While migraine surgery is not a ‘one-stop-shopping’ cure for headaches, it is increasingly shown to be very effective, especially with correct patient selection and ongoing medical management by a neurologist.”
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In studies, nerve release surgeries, while still considered experimental, have shown that 80 percent of patients treated, experienced improvement in the number and intensity of symptoms, and 50 percent of patients have complete relief from headaches. At 5 years post surgery, nearly 90 percent of treated patients experience on-going symptom relief.
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