eurekalert.org/pub_releases/ … 072814.php
Another interesting article on a surgical approach to migraine relief. Again, the million dollar question is if this surgery would also relieve VM.
The question is why would you do it? It seems to be the same plastic surgeon from the previous article, who has done cosmetic procedures where a side-effect seemed to be less migraines, in some people.
So is he now looking for ways to value-add his business? There’s a lot of snake-oil salesmen out there and not just on the complementary medicine side. My view is, this is at the extreme end, I also think having botulism toxin injected into your head for no good medical reason is extreme folly.
But if it has worked for migraine, why not just continue with botox, why have surgery?
Why are the muscles “overactive” and compressing the nerves in the first place, is it some sort of chemical reaction, starting from the brain itself? What comes first, the chicken or the egg?
Surgery to cut and remove muscle and connective tissue is just treating one symptom. What about scar tissue formation, don’t the muscles/tissue hold the bones in place, you could be substituting one set of problems for another.
I did find the illustrations of the nerves in the head and neck interesting, I can’t look at the surgery photos, but I just think there is less invasive ways to relax muscle and fascia. Everyone wants the quick fix, but sometimes slow and steady wins the race. (fable for today)
Sheesh, Rebzi. Obviously, you’ve made it loud and clear this is not the procedure for you. But I am a member of another forum for which this surgery has literally changed the life of people who have tried everything else to achieve relief from horrific pain. I am not a shill for a cosmetic surgeon (aka “snake oil salesman”) looking to expand her patient base. I am passing along information that may be of use to someone in this group. If it’s not for you, fine.
And, I hardly think people would inject Botox into their head without a “good medical reason.” There are some people who receive great pain relief by paralyzing muscles in the head/neck. I don’t think people would just go around injecting paralytic agents into their head (other than cosmetically) unless they believe it may be of some help. (In fact, insurance companies in the US will not pay for Botox unless the patient has first tried and failed a trial with a variety of traditional migraine meds.) It helps some but does nothing for others.
As for why someone would consider surgery if Botox has helped, I think there are some people who receive only partial relief with the medication and are looking for more symptom relief and are not willing to accept a “slow and steady” approach that may or may not work. The surgeons doing this procedure use it as a last attempt for pain relief. They have pretty strict criteria that must be met prior to agreeing to the surgery. It’s ridiculous thinking anyone would just jump into it without first trying many medications. No one here is suggesting otherwise.
Some of the people on my other forum have developed migraines due to nerve compression by muscles or blood vessels after suffering a trauma (hit on the head/neck or whiplash are the most common events). My neurologist explained to me that once a nerve is irritated, the surrounding muscle can enter a chronic spastic state causing more constriction to the nerves that run through and underneath the muscle. Sometimes trauma can lead to a neuroma (scar tissue build-up) in the muscle that compresses a nerve. And I suppose some people are just born with a certain placement of the nerves that makes them more prone to compression by surrounding muscle when the person is tense or whatever. Obviously, this is not the only explanation for migraine. Researchers are fairly certain there is a chemical involvement in some people with migraines, which is why treatment with calcium channel blockers & anti-depressants can be effective in some cases. And I should add that in the right sub-set of migraine folks, this procedure is not just treating a symptom (as you suggested) but is addressing the underlying cause of the pain.
I’m not sure what bones in the head are being held in place by muscles and tissue. What are you talking about? Nonetheless, all surgeries have risks that must be considered and a risk/benefit analysis is prudent in consideration of any surgery.
I hope no one is hung up on the idea that this procedure is performed by cosmetic surgeons. Plastics docs are specifically trained and have extensive experience in surgeries involving peripheral nerves, unlike neurologists, neurosurgeons and general surgeons.
I, for one, believe one of the primary benefits of this forum is to share information that may be of help to some readers, but probably not all. That’s nice you have your own opinion regarding this surgery, but to suggest the docs doing this surgery are snake-oil salesmen when you obviously know nothing about the procedure is offensive.
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Maybe “cowboys” is a better description
In 1980, Stanford trained Dr. John Epley, a Portland, Oregon ENT, presented to a group of fellow ENTs a demonstration of a strange series of head positions he devised to reposition inner ear crystals to a place that caused an immediate cessation of a BPPV patient’s vertigo. Many in the audience laughed and walked out of the room in disgust.
Over the next few years, his colleagues reported Dr. Epley to his hospital ethics board for performing such a non-conventional maneuver, and other doctors considered him a quack and stopped referring him patients. Medical journals refused to print Dr. Epley’s articles that described his success rate in curing people of their vertigo. Dr. Epley persevered and tried to spread the word only to be jeered and ostracized.
It wasn’t until 1992 that the Journal of the American Academy of Otolaryngology published Dr. Epley’s case study describing a 100% cure rate in his “canalith repositioning” maneuver in 30 patients. Despite this, his colleagues continued to jeer him, and many doctors still dismissed Epley as a crank.
“The conflict flared into a crisis in 1996. The Oregon Board of Medical Examiners notified Epley that he was under investigation for alleged unprofessional conduct.” After dragging on for five years, the state hearing office finally ruled and allowed Dr. Epley to keep his medical license. Today, the ENT community accepts Dr. Epley’s theory of displaced ear crystals as the cause of BPPV, and the Modified Epley Maneuver is considered the primary treatment.
"In an interview Epley reflected on the reasons other doctors refused to accept his findings for so many years.
“If I look back at medical school, much of it was misinformation,” he said. "Physicians learn to just do the routine, to do the accepted things – don’t go too far out.
“They’ve got so much to lose if they stick their neck out.”
dizziness-and-balance.com/di … 202006.pdf
aliveandwell.org/html/the_bi … _cure.html
Dr. Epley died only recently after suffering a massive stroke. I’m sure many of his colleagues believed him to be a “cowboy”- reckless and irresponsible. Look how that turned out.
I have a headache… and, rather lovely vertical lines between my brows.
A good read from medscape.com/viewarticle/807393#1
“Neurologists Don’t Buy ‘Facelift Treatment’ for Migraine”
Pauline Anderson
July 05, 2013
partly printed below:
"Arguing against the procedure, Hans Christoph Diener, MD, PhD, professor and head of neurology, University Hospital and Essen Headache Center, in Germany, said it should be strongly discouraged.
Migraine, Dr. Diener pointed out, is a multi-gene-related disorder of the brain, so it does not make sense that deactivating a nerve would be useful.
“Let’s face it: migraine is a very complex disease of the brain; how could surgery affect the epigenetics of 22 different genes?”
He noted that “biological plausibility” and “experimental evidence” are “totally absent” in the studies of the procedure."
Well then. I guess someone should let those people who have been helped greatly from the surgery know that their improvement is biologically implausible. After all, migraine must be a result of genetics in all cases and nothing else. Good grief.
It’s strange to be attacked rather aggressively like this by you, when i am contributing my point of view to a public forum.
YOU put it out there, I was attempting to participate in a discussion. I’m just posting my opinion, backed up by the article mentioned.
— Begin quote from “Rebzi”
I have a headache… and, rather lovely vertical lines between my brows.
A good read from medscape.com/viewarticle/807393#1
“Neurologists Don’t Buy ‘Facelift Treatment’ for Migraine”
Pauline Anderson
July 05, 2013
partly printed below:
"Arguing against the procedure, Hans Christoph Diener, MD, PhD, professor and head of neurology, University Hospital and Essen Headache Center, in Germany, said it should be strongly discouraged.
Migraine, Dr. Diener pointed out, is a multi-gene-related disorder of the brain, so it does not make sense that deactivating a nerve would be useful.
“Let’s face it: migraine is a very complex disease of the brain; how could surgery affect the epigenetics of 22 different genes?”
He noted that “biological plausibility” and “experimental evidence” are “totally absent” in the studies of the procedure."
— End quote
Genes can make you bald and surgery can give you hair back - doesn’t change your genes but alleviates the symptoms. A pretty spurious argument from Dr, Diener.