Headed for Relief
Migraine surgery alleviates chronic migraine sufferers’ pain.
Until recently, effective treatment for chronic migraine headaches was a medical mystery, stumping doctors and leaving migraine sufferers in pain. “You look at the history of how migraines are treated and the theories behind migraines, and to this day, there are multiple theories about the source of migraines and what causes them,” says Dr. Oren Tessler, a microsurgeon specializing in plastic and reconstructive surgery at Louisiana State University Health Sciences Center.
But in 2000, a plastic surgeon named Dr. Bahman Guyuron discovered a surgical method of migraine treatment that offered incredibly successful results. “To make a long story short, what they found was that if you free up some of the nerves that innervate the sensation to the face, a lot of people will get significant relief of their migraines,” Dr. Tessler says. “It led to a lot of studies — and the differences were amazing.”
For a subset of patients, nerve compression and irritation at the point where a nerve leaves the skull can be significant contributors to chronic migraines; with the “release” of these nerves and the alleviation of pressure and irritation, the migraine’s root pain dissipates.
During the past few years, migraine surgery has been performed at major hospitals and medical centers across the U.S., including Georgetown University, Johns Hopkins University and Harvard University/Massachusetts General Hospital — and now, Dr. Tessler and his colleagues are performing the surgery at LSU Health Sciences Center.
“We made sure here [at LSU] that we were working with the other specialists before we began doing anything,” Dr. Tessler says. “We just want patients to know that there is at least an opportunity for them to get evaluated.”
To determine if a patient is a candidate for migraine surgery, Dr. Tessler injects Botox to temporarily shut down nerves in certain areas of the face and the back of the head. “Botox is used for thousands of conditions, and one of the biggest uses is shutting down pain,” Dr. Tessler says. “If patients’ migraines have a component where we can eliminate pain by shutting down nerves, then they’re basically candidates.”
Migraine surgery can be performed via an approach through the forehead, or through the eyelid. Dr. Tessler prefers working through the eyelid, as it provides easy access and creates a minimal, well-hidden scar. “We have access to all of the frontal triggers through the eyelid,” Dr. Tessler says. “We release nerves in the forehead and the temple. If we need to do it in the back of the head, we’ll do that as well.”
He notes that migraines are localized, so it’s important to make sure all of the irritated nerves are released. “The head is very expensive real estate,” he says. “Everything lives very close together. Everything is running over or under something.”
In a recent paper Dr. Tessler co-authored at Massachusetts General Hospital, 90 percent of patients saw more than a 50-percent improvement in their symptoms, and more than 50 percent of patients reported total relief from chronic migraines. In this study, migraine surgery was exponentially more effective than previous methods of chronic migraine treatment — in fact, “Chronic migraines were not responsive to any other form of treatment,” Dr. Tessler says. “It is a very successful surgery … It’s one of those surgeries that’s very rewarding.”
Dr. Tessler and his team are now accepting patients for evaluation and potential surgical candidacy. “We wanted to make sure that even if insurance didn’t cover it, it’s affordable,” he says. “We’re trying to get a roll-out on this.”
Oren Tessler, M.D., C.M., M.B.A., F.R.C.S.C.
Assistant Professor of Clinical Surgery
Chief, Division of Plastic and Reconstructive Surgery
University Hospital, LSUHSC
New Orleans, LA 70112
MEDICAL SCHOOL: McGill University
RESIDENCY: Plastic and Reconstructive Surgery, McGill University
FELLOWSHIP: Microsurgery and Reconstructive Breast Surgery, Massachusetts General Hospital