Migraine Relief: The Longest Lasting Cure for Migraines

Announcer (00:01):
You are listening to Head On with your host, board certified plastic surgeon, Dr. Bahman Guyuron, the pioneer of a life-changing surgery for permanently eliminating migraines and a specialist in plastic surgery of the face, head and neck.

Dr. Guyuron (00:18):
Migraine headaches or severe headaches which often are associated with nausea, vomiting, aura. Normal headache, conventionally, the headaches that are not really migraine, they usually do not cause nausea, vomiting, fear of lights, fear of sounds, and that's how the diagnosis of migraine headaches are made. Yeah, there are two different reasons for classifications. There is a classification that our neurology colleagues have episodic, chronic, and headaches that can cause paralysis, paralytic migraine headaches. That is one classification for their definition in terms of neurology. But we also have a classification in terms of surgical treatment like a frontal migraine, meaning frontal headaches that are start from the forehead. Occipital migraine, headaches that start from the back of the head. Temporal migraine headaches start from the temple. And the reason that we have our own classification is mainly the surgical treatment is going to be a little bit different. So we need to identify the trigger site before we operate and the patients actually lead us to that conclusion as to where the headaches are starting from. When patients tell us we have migraine headaches, my first question, where do they start from?

(02:00):
Sometimes it is a little bit vague in the beginning, but with persistence I can usually get the patients focused on where the headaches starting from. But there are some patients that actually they walk to our offices, my headaches start from here or from the top of the head, so I know anatomically where they're triggering from so I can target the surgery and eliminate or deactivate that trigger site. Many of the migraine headache patients have headaches originating from behind the eye, eyes, and those are the headaches that are originating essentially from the nose and the septum and turbinates. Inside the nose we have a wall that is partitioned that's called the septum and projections that come off the sidewall of the nose. And when there's any contact between those two structures can trigger headaches. There are the reasons that we don't need to get into the headaches can originate from inside the nose.

(03:11):
As far as the ear is concerned, the ear itself actually is not really a component of a headache. But there are vessels right in front of the ear that travel towards the top of the head and those vessels can trigger headaches that start in the temporal area. And that's the hair bearing temporal area where we have another nerve down here between the eye and the sideburn, and that is a different type of temporal headache and the nerve that is involved in that process is a little bit different. So ear is not really originator of the headache, but vessels in front of the ear and the nerves in front of the ear can start the headaches. In many of the trigger sites where the headaches are originating from, the nerves are irritated by the vessels that ordinarily run side by side. Sometimes the vessel crosses the nerve or the nerve crosses the vessel.

(04:19):
And in those situations, if the patient has tendency to migraine headaches is going to have migraine headaches. And the reality is that patients do not have tendency to have migraine headache, those nerves and vessels cross each other, but they never cause problems or the vessel doesn't irritate the nerve. And we have actually demonstrated scientifically that vessels are the major factor. And we have also demonstrated scientifically that patients of migraine headaches are missing a membrane that is called myelin, which is an insulation around the nerve that is damaged genetically. That damage can also be related to an injury, like a whiplash injury. And when the myelin is damaged pulsation of the vessel that doesn't ordinarily irritate the nerve becomes a problem and it irritates the nerve. And we have demonstrated by removing those vessels we can actually stop the headaches. And that is actually not only we have demonstrated in on the face and periphery and is a neurosurgery procedure to separate the vessel from the nerve that is called the trigeminal nerve inside the bed, under the brain to get rid of another version of a facial pain, that is the severe facial pain and it's called a facial neurologia, and it involves all of the branches of the facial nerve. And the neurosurgeons do the same thing, they separate them, they put an insulation in between the nerve and the vessel so that the pulsation of the vessel doesn't irritate the nerve. So that's a phenomenon that is known, but we have demonstrated again that scientifically. But the main cause of the migraine headaches and most incidences is genetic disposition. An overwhelming majority of our patients on whom I have operated on have family history of migraine headaches. But as I mentioned earlier, the injury that is going to cause a trauma to the myelin or damage the myelin can also cause headaches like migraine headaches. So that would be obviously the origin of the migraine headaches. Now the factors, the triggers of migraine headaches as I mentioned, one is the vessel that we talked about, but one is the contact that I mentioned inside the nose.

(07:29):
The other one that is a major factor in some sites, like in the back of the head, center back of the head, or in above the eyebrow, the muscles that we use for frowning can cause headaches. In fact, that's how I discovered that surgery works for migraine headaches. Well because we were removing the muscle frowning muscle to improve the appearance of the forehead. And those patients told us that they no longer have migraine headaches. And this similar experience came across with the Botox. What Botox does paralyzes the muscles, although Botox also has some benefits in terms of reducing the inflammation which reduces the headaches but may not take it away completely the way surgery does. When the surgery works, headaches go away completely. When the patients have a migraine headache all the nerves are more irritable, more sensitive. All sensations are sensitive including the vision and the light that doesn't bother them when they don't have migraine is going to bother them. Sound that really bother them, causes more irritation of the deterioration of migraine headaches cause more of this feeling of getting worse. And the migraine headache may not be getting worse, but it is just that they sense it more intensely because of this aspheric changes, noise around them. So those are the factors that govern as to why patients who have migraine headaches are more sensitive to light and sound. And that's as I mentioned earlier, that's actually fear of sound, noise is part of migraine headaches and because the nerves are more sensitive. In fact many patients also have more migraine headaches during the periods, menstrual periods or at least more intensely because during the menstrual periods the nerves are more sensitive, ladies' nerves are more sensitive, more irritable, and that's why the incidences of migraine headaches increases during the menstrual period. They go hand to hand. Chronic migraine headaches is more than 15 severe migraine headaches a month.

(10:20):
That includes all the symptoms that we talked about, meaning combination of headaches and nausea and vomiting and light sensitivity. Fewer than 15 describes episodic migraine headaches, meaning there are days that patients don't have migraine headaches, although some patients have one migraine headache, there may last five seven days, but by definition that may not be migraine. But there are patients that will describe it as a three or four or five days continuous migraine headaches. And if they get 10 of those, essentially they're migraine headaches every day. But the neurologic field definition of chronic migraine is what I just described, more than 15 migraine headaches a month that they're intense and include symptoms that I talked about. Many of the triggers of migraine headaches fall and two major categories, physiologically, elements or activities or incidences where the blood pressure is going to go up. If you recall, I indicated that actually in migraine headaches have a vessel pulsation as a component of beginning cascade of migraine headaches.

(11:51):
So anything that's going to raise blood pressure is going to increase the blood flow on a vessel right next to the nerve that irritates the nerve. So that's going to like stress. Some people get migraine headaches with exercise because obviously when we exercise, the blood pressure goes up, pulse rate goes up, blood flow. Although after they finish for example, jogging for three or four mile, if they can stand the headache, the headache may subside because the blood pressure is going down and also endorphins are released after heavy exercises. The other factor is anything that is going to increase the irritability of the nerves or sensitivity of the nerves such as chocolate or caffeine. Sometimes caffeine actually helps because caffeine can actually shrink the vessels and reduce the irritation, but most of the time in the beginning is going to increase the nerve sensitivity. So the smart thing is to reduce anything that is going to increase the blood pressure like stress.

(13:15):
We don't want anybody to stop exercising and/or stay away from those food products that are going to increase the sensitivity of the nerves. I don't personally manage the patients medically. My role is when the patients get to the point that nothing helps them, that would be the time that I would do the surgery or if they're taking medication they don't tolerate the medication and migraine headaches are change the quality of life for them, we will offer surgery. Overwhelming majority of patients that I see for relief of migraine headaches have already explored everything including all the available migraine medications, injections, acupuncture, and even some minimally invasive techniques like radio frequency, treatment of the nerves, nerve blocks and Botox. And many of those obviously give some relief, but none is going to give the patients relief that they are looking for hopefully for a lifetime, at least for a long time.

(14:45):
And surgery becomes a really good choice for them because it does provide lasting and reliable relief. And most of the times it is a complete relief. Now in some patients I may get 65, 75, 80%, 90% improvement in the first operation. But with additional tweaking and smaller procedures, we get them complete elimination. In fact, in every patient, my end goal is to have complete elimination of migraine headaches. And I can tell you that there's some patients that actually come to my office sitting there smiling and very happy. And I ask them, so how are you? They say you don't understand you have changed my life. And are they gone completely? No, 75%, 80%, 90% are gone but not completely. And I'm looking serious as thinking actually why is that? It is not a hundred percent. I'm asking them questions and they look at me sort of like, are you silly?

(16:14):
I'm very happy actually with what the improvement that I already have achieved. But I say, I tell them what, I don't get thrilled until you tell me that your headaches are gone completely. So I look for it and I find it, I usually find a way to take the headaches away completely, and that is when I become satisfied. And again with the second and sometimes with the third operation, but subsequent, smaller, minor procedures, we can give even the patients who have had multiple trigger sites, complete elimination of headaches. So that's what I call relief. That's what really makes me very gratified with what I'm doing for that particular patient. Many of the patients who see me, actually, this is not an exaggerated statement, many tell me that if you, you're my last resort and if you cannot help me, I don't want to live because I don't have a quality of life.

(17:28):
And that doesn't apply to obviously every patient. And they're not suicidal psychologically, they're suicidal logically because they don't have quality of life. And when the surgery works for them, they are extremely happy. I have had many, many students that they actually could not go to college, could not follow education because of migraine headaches. And unfortunate part of many of the migraine medications that they reduce the cognitive function. Essentially what the medications are doing dulling the brain, the pain is not felt and the education is not fun for them because they cannot really comprehend the way they used to before the mild migraine or between migraine. But the migraine headaches are so frequent for them that they can't participate in the classes and often they have to leave in the middle of class. So those are the patients that act after the surgery, and I have many of them. They have been able to go back to school and finish, get their degrees and start families.

(18:56):
Over the last almost 25 years that I've been doing this, I have had many, many stories like this. So overwhelming majority of my patients that are seeing me, they don't have any quality of life. I have operated on patients as young as 12 or 13, and I've also operated on patients who were in the late eighties. And for any age group when there's no quality of life or the quality of life is so disturbed that they can't enjoy their life anymore again, surgery is an option and it helps them tremendously. And we've done studies in adolescent patients to see if it works as well, as well as it does in adult patients and demonstrated that the success rate is pretty much equal for both groups. So the relief that surgery offers is through identifying the trigger sites and removing the vessels, releasing the nerve with the small branches, we will remove the branch. With a larger branches, I save the nerve.

(20:31):
And depending on where the trigger site, the surgery is going to be slightly different, but overwhelming majority of the patients now have this surgery under local anesthesia through a small incision, go back to work the same day or the next day and resume their lives the next day. There are patients that they need a week or so recovery, the social recovery, and some patients need actually three weeks of recovery. The relief that we offer is very different from medications. In fact, even those who do not have a hundred percent elimination of migraine headaches and they have 85, 90% relief, they tell me that actually for them the medications are working a lot faster and the intensity of the headaches are reduced and frequency is not the same, it is a lot less. So we help those patients in every way possible. And the reason that they're so happy actually with the outcome because of those factors, even the headaches do not go away completely.

(21:51):
And we have been able to do long term studies on these patients and we have demonstrated there's no difference between the first year after the surgery and five years after the surgery in terms of the results. And that has been scientifically proven. So because of that, that I can claim that this is a long lasting relief, and again, it is not a suggestion is a scientifically proven fact that the surgery provides long lasting relief. Anybody who is considering surgery and wants to understand more about it, I suggest that they go to my website, a website of many of the individuals that I have trained nationally, internationally. Learn a little bit more about what the surgery does and we have many patients who have volunteered to talk to the patients who are considering this surgery. And also look into the number of studies that have been done outside of studies that I have done nationally, internationally. There are now three books published about migraine surgery. I published the first one and now there are two other books have been written about surgery. I think a common statement that some of the patients hear from the neurologist that this is an experimental surgery. Experimental surgery would be a year or two. We have been doing this for almost 25 years and I've done thousands of it and many studies have been done in many centers and everybody comes to the same conclusion that surgery works, surgery effective, surgery is safe.

Announcer (23:53):
Links to learn more about Dr. Guyuron and anything else mentioned on this podcast are available in the show notes. Head On is a production of The Axis, theaxis.io.