These days, whenever I read the news or look online, the world can seem like a pretty bleak place. The political divide remains, natural disasters abound, and trade wars are imminent. However, just when things seem pretty dark, little rays of light seem to peak through the clouds. This past weekend, I had the distinct honor and privilege to serve on a panel about migraine/headache surgery at the international meeting of the World Society for Reconstructive Microsurgery in Bologna, Italy. I was speaking and interacting with several esteemed colleagues in this burgeoning field from around the world. Amongst the highlights of this event (and there were many) was the feeling amongst several of my colleagues that a few neurology counterparts in their communities had begun to embrace the idea that surgical intervention might just have a role in the treatment of chronic headaches.
It reminded me of the time Dr. Pamela Blake spoke on our on our panel teaching headache/migraine surgery at the American Society of Plastic Surgeons annual meeting two years ago. Dr. Blake is a board-certified neurologist, an active member of the American Headache Society & International Headache Society and former Director of the Headache Clinic at Georgetown University. She remains active in research in behavioral neurology and cognitive science and served as volunteer faculty at the Cognitive Neurosciences Section at the National Institutes of Neurological Disorders and Stroke at the National Institute of Health. As impressive as this resume is, perhaps the most impressive thing to me, however, is that Dr. Blake is a firm believer in the concept that peripheral nerve pathology is a very under-recognized factor in the generation of chronic headaches for many people. Just last year, she published an article detailing some success with the surgical approach in Cephalalgia, a peer-reviewed journal and the official Journal of the International Headache Society.
While this fact may seem trivial to many, I cannot overstate what it means to those of us who have been banging on this door for over ten years. Since 2000, there have been over 80 scientific articles from numerous centers across the US, Europe and Asia detailing positive outcomes from nerve decompression surgery for chronic headaches such as migraines. Last year the American Society of Plastic Surgeons issued a formal policy statement that headache/migraine should no longer be considered “experimental” when other treatment modalities have failed.
If someone with Dr. Blake’s background and training can be convinced by the available evidence and our results with headache surgery patients that we are onto something, then perhaps others can be convinced similarly. In my humble opinion, this change would be nothing short of revolutionary as it would finally give peripheral nerve surgery a seat at the table in the armamentarium of modalities that could be considered in the treatment of chronic headaches in particular and perhaps chronic pain in general. Perhaps in the not-too-distant future we will see positive position statements from various other societies and if things go really well…. a change in the overall medical establishment’s perspective. When I think of the hundreds of thousands of people who may find relief from the scourge of chronic headaches like migraines, a big smile begins to creep across my face. Dare to dream big….. I remain ever hopeful, but more optimistic with each passing day. The longest journeys begin with the smallest steps.