- Arlene Harris could not stand the pain any more. She
suffered from debilitating migraine headaches that would last for days,
- "They would start in the back of my head,"
recalls the 53-year-old from Cleveland, Ohio. "It would feel like
someone was stabbing me in the back of my head with a knife." To make
matters worse, the frequency of the attacks was increasing at an alarming
rate. "It seemed the older I got, the worse I got."
- The drugs normally used to treat migraines barely made
a dent in her pain. "I was at the point where I was willing to try
anything," she recalled in a telephone interview.
- So, when she saw a television news report about a Cleveland
doctor who performed a unique migraine operation, Ms. Harris leaped at
the opportunity. "I figured I had nothing to loose."
- The operation, developed by Dr. Bahman Guyuron, a professor
of plastic surgery at Case Western Reserve University, involves the surgical
removal of tiny bits of muscle from the face and head to release pressure
on particular nerves.
- Although it may sound bizarre, the surgery works for
some patients who can't get relief from conventional treatments. And it
seems to be long lasting.
- Three years after her surgery, Ms. Harris is still almost
migraine-free. She might suffer a few attacks a year -- during particularly
stressful periods -- rather than many episodes a month. "I don't miss
time from work any more because of migraines. I can spend more time with
my family. I can function like a normal human being," said Ms. Harris,
who works in a tony fabric store.
- Dr. Guyuron decided to explore a surgical solution to
migraines after some of his patients reported that their headaches had
suddenly stopped. They had undergone minor operations to have frown lines
removed -- and surprisingly got rid of their migraines as well.
- So he set out to systematically study which muscles and
nerves seemed to play a role.
- He identified several key areas for surgical intervention,
including around the temples, forehead, nasal region and back of the neck.
- Migraine sufferers are well aware that certain triggers,
such as stress or particular foods, can bring on an attack. But the exact
cause of the headaches is unknown.
- According to one theory, highly sensitive brain cells
send out signals leading to a dramatic constriction of certain blood vessels
in the head. Then, the same brain cells send out the opposite message,
forcing blood vessels to open wide. These extreme swings put huge stress
and strain on blood vessels, nerves and muscles, provoking excruciating
- Dr. Guyuron's treatment essentially eases the pressure.
Through tiny incisions, he removes bits of muscle wrapped tightly around
specific nerves, then pads out the depression with fat taken from another
part of the patient's body.
- "When the muscle contracts, it is not able to pinch
a nerve," the doctor explained. In certain cases, he also severs non-crucial
sensory nerves, rather than tinker with an important muscle, such as those
that control chewing.
- Botox injections are used to help pinpoint the areas
that require treatment. In fact, doctors have been using Botox for years
to treat migraine sufferers. Botox, an extract from the botulinum toxin,
deadens nerves and thus relaxes muscles. (That's why Botox is also used
to smooth wrinkles and eliminate frown lines.) But within a few months,
nerves grow back, so the relief is temporary.
- Dr. Guyuron has found that patients who respond well
to Botox injections are good candidates for his more lasting treatment.
"Each patient may have a combination of trigger sites. We identify
them and treat them surgically," he said.
- Still, this type of surgery "is not for everyone,"
said Dr. Jennifer Kriegler, a neurologist who has collaborated with Dr.
Guyuron on a recent study published in the journal Plastic and Reconstructive
Surgery. "These are people who have really intractable migraines.
They are significantly disabled."
- A handful of other doctors across the United States are
now doing the operations. There are none in Canada yet.
- "Dr. Guyuron is clearly the man. And I am copying
him as best I can," said Dr. David Branch, a plastic surgeon in Bangor,
Me. "So far, so good."
- Treatment can be pricey. Depending on how many nerves
and muscles need surgical intervention, the price can range from $3,000
to $25,000 (U.S.). But Dr. Branch believes the treatment can save money
in the long run because patients are no longer losing time from their jobs.
As well, some do not have to take costly migraine drugs any more.
- Some patients will experience numbness in certain areas
as a result of the surgery, but this complication is usually temporary,
said Dr. Guyuron.
- And there is one side effect most patients welcome --
the loss of their frown lines.
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