In this second installment about fears and misconceptions about headache/migraine surgery, I’ll address several other concerns people have raised when considering these procedures. As before, hopefully these discussions are helpful in making a more informed choice about whether such procedures are right for you.
- Misconception 3 – The results of surgery are only temporary and the pain will eventually recur. I often tell patients that it may be scar tissue that is pressing on their nerves or preventing them from gliding back and forth as they move their neck and hence cause pain. Patients naturally ask why more scar tissue wouldn’t form after their operation. This question is a good one. The answer is that scar tissue always forms after any operation, but excessive scar tissue that re-entraps nerves can be mitigated by creating sufficient space around the nerves during the operation and by allowing/instructing the patient to move their neck normally as soon as they wake up. We know from our work on tendon injuries in the hand that as little as 5 mm of gliding can prevent clinically significant adhesions and the same physiology holds true in other parts of the body and with respect to nerves. To back this fact, the 5-year results from these operations were actually published back in February 2011. In this study, 5 years following their operations, 88% of patients were still reporting at least a 50% reduction in frequency, severity and/or duration of their symptoms and 29% were completely migraine-free. In the medical cancer literature, if you are free of your disease after 5 years, you are typically considered to be in remission. Similarly, if you are significantly better or migraine-free after 5 years, we consider these essentially permanent results.
- Misconception 4 – My insurance considers these operations experimental which means they are unproven. Sorry, but I get on a bit of a soap box about this one. In my humble opinion, insurance companies are not the arbiters of what is medically appropriate. That decision is between the doctor and the patient – period. Your insurance company doesn’t know you, hasn’t examined you, hasn’t spoken with you about your condition and hasn’t evaluated your records. The American Society of Plastic Surgeons put out a formal position statement regarding headache surgery which clearly states that when more conventional modalities have failed, that these operations are not only reasonable, but should be considered the standard of care. This 13-page document is exhaustively researched and cites 89, peer-reviewed articles in high-impact factor journals, which speak to the efficacy of this approach to chronic migraines/headaches. It continues to boggle my mind why insurance companies claim this treatment approach is unproven because it is simply untrue.
- Misconception 6 – I had a nerve block with another doctor which was unsuccessful and therefore I am not a candidate for these procedures. Results of the nerve block will vary based upon several parameters: what you inject, how much of it you inject, where and how you inject, and for what reason you are injecting. I can’t tell you how many patients have told me that they had a nerve block of the greater occipital nerve which was unsuccessful, but when I ask them if the back of their head was numb at all, they reply ‘no’. If you have no numbness following a nerve block, that means the nerve was not blocked and simply put, you have had no idea whether or not numbing that target nerve would give you a successful result. Therefore, if nothing else, if the nerve block which was performed initially was unsuccessful, then may be a repeat block performed in a slightly different way with a slightly different technique may be successful. It is thus important to have these blocks performed sequentially and by a clinician with a reasonable amount of experience with these procedures.
Hope these explanations help to some degree. In a future blog post, I plan to address still other misconceptions that seem to strike fear in the hearts of those considering an operation for relief of their chronic headache pain.