One of the more interesting questions that has come up recently is whether or not a person is safe for surgical intervention if they have other medical conditions. This query is very important and was addressed in part on a recent episode of Burning Migraine Questions on FB Live, but I’d like to go into more detail here.
The first item that needs to be in place is an accurate diagnosis and cogent surgical plan. After all, if a person is having the wrong operation, or it is performed inadequately or both, the outcomes will be suboptimal. The best way to address this issue is to see a headache/migraine surgeon who not only understands the pathology for your particular case and has experience in treating it, but also has specific training in doing so and who understands you and your particular challenges. All of these points have been discussed in greater detail in a previous blog post (How To Choose A Headache Surgeon), but the latter item is the focus of this particular entry.
Since every patient is unique, each will have a specific nerve or nerves that will need to be addressed. Further, each patient will have different medical problems that have nothing to do with their nerve issues. While no operation (or medication for that matter) is without potential risk, the most important thing a surgeon can do is give the patient as safe a procedure as possible. In some patients, especially those above a certain age and/or those with pre-existing medical issues, a thorough medical workup by the patient’s primary care provider is important in achieving that goal.
For example, one patient may have an aneurysm in a large vessel. This patient clearly needs to see a vascular surgeon before undergoing headache surgery. While headache surgery is significant, an aneurysm may be life-threatening and should be addressed first. If cleared and the patient is deemed a candidate for surgery, then they can reasonably proceed.
Alternatively, if a patient presenting for headache surgery is on blood thinners because they have an abnormal heart rhythm, that person must be cleared by their cardiologist before entertaining surgical intervention. The cardiologist and headache surgeon must confer on how to manage that patient’s anti-coagulation around the time of the planned procedure.
Finally, one of the more common issues is how to manage pain medication. Many patients presenting for headache surgery are on a lot of pain medications because of the severity of their symptoms and the inevitable question arises, “Who will manage those medications before and after the operation?” Do you add another medication to deal with the acute on chronic pain following an operation in a chronic pain patient or do you double the current dose of medication? There is no one right way to handle this issue, but again, a thorough discussion needs to take place between the patient, the headache surgeon and the person prescribing those medicines.
One of the key aspects of a headache surgeon’s role is to understand you, not as a disease or a medical challenge, but as a person with a medical problem. We can only do that in partnership with your existing medical team.