Migraine Surgery: is it effective?

Migrate surgery
عنوان فوق مطلبی است ک در سالهای اخیر بیشتر مطرح شده است و طرفداران و مخالفانی دارد. جهت اطلاع بیشتر از نظرات صاحب نظران در این مورد دو مقاله در دسترس هستند که در قسمت آموزشی سایت مقالات آن وجود دارد. مطلبی را که در ادامه می خوانید مطلبی است که از طرف جناب آقای دکتر انصاری همکار گرامی ما در آمریکا و عضو ارتباط دهنده انجمن سردرد ایران به انجمن جهانی سردرد هستند ارسال نموده اند. جهت اطلاع عرض می شود پرفسور غیوران و دکتر توتونچی همکاران جراح پلاستیک آمریکا در تاریخ 24 تا 28 فروردین 1395 در ایران حضور دارند و می توان مواردخاصی از مبتلایان به میگرن مقاوم را در صورت تمایل جدی بیماران و پیشنهاد پزشک معالج و داشتن شرایط خاص جهت جراحی میگرن معرفی کرد. اگر همکاران ارجمند تمایل به ارجاع بیمار دارند خواهشمند است مشخصات در نظر گرفته شده را مد نظر قرار دهند. ضمنا فرم ساده ای که توسط دکتر تقا طراحی شده را باید بیماران برای مشخص کردن نوع سردردشان از حداقل 3 ماه قبل از ارجاع پر نمایند که فرم نیز در سایت گذاشته شده است . خواهشمند است مشخصات بیماران ارجاعی را نیز ثبت و ارسال فرمایید. ایمیل:[email protected]

دکتر منصوره تقاء

Articles:

Is Migraine Surgery Ready for Prime Time? The Surgical Team’s View

Migraine Trigger Site Surgery is All Placebo

Five-Year Outcome of Surgical Treatment of Migraine Headaches

Electron Microscopic and Proteomic Comparison of Terminal Branches of the Trigeminal Nerve in Patients with and without Migraine Headaches

It is with great pleasure to announce that Prof. Dr. Bahman Guyuron and Dr. Ali Totonchi will be travelling to Tehran in collaboration with Iranian Headache Association (IHA) for a few days of “migraine surgery” and lectures regarding this topic.
Prof. Bahman Guyuron, the former chairman of the Plastic Surgery Department in Case Western Reserve University, emeritus professor of plastic surgery and former director of American board of plastic surgery, is the pioneer of the migraine surgery procedures with numerous publications and ongoing studies in this topic, His inventions dates back to 15 years ago and since then this innovative field has been evolving rapidly. He continues to streamline, use more objective information for detection of the trigger sites and simplify the techniques with better outcomes.
Dr. Ali Totonchi is medical director of the Craniofacial Deformity Clinic in Metro Health Hospital in Cleveland, Ohio. He completed 8 years of training, combination of full residency, research and clinical fellowship with professor Guyuron and is very active in surgical treatment of migraine headache. He recently presented his outcome data on Migraine surgery in collaboration with Dr. Hossein Ansari
(International Liaison of IHA) during International Headache Society meeting in Valencia, Spain.
In preparation for these surgeries we ask our colleagues to consider the patient for surgery with following criteria:
Inclusion criteria:
1. Diagnosis of the Migraine Headache by Neurologist base on ICHD‐3, beta version

  1. Having identifiable localized trigger point(s) in head and neck area, these trigger point(s) are easily detected by a detailed history and asking the patient to pay attention to the area which the headache
    starts from. The most practical way is to ask the patients to keep a headache log for 4‐6 weeks and mark the start point of headache on the diagram. The log form with diagram are provided.
    Physical examination is usually used to confirm the trigger points, in most of the trigger points the nerves in the area are tender to touch, nasal trigger points require intra‐nasal examination for septal deviation or turbinate hypertrophy and most importantly CT of the paranasal sinuses for those patients who have migraine headaches from behind the eyes. (Interested physicians can review the article provided regarding detection and anatomy of the trigger points.)

  2. Poor response to medication either due to ineffectiveness or developing intolerable side effects.
    Preferably patient should have tried at least 3 medication from three different class of approved Migraine preventive medication (Anti‐hypertensive, Anti‐depressant, Anti‐epileptic) with “appropriate”
    dose and duration.

  3. Migraine interacts with patients daily activities. Different measurement tools can be used in this regard. We recommends, Headache Impact Test (HIT‐6). This will be used for the follow up and response to treatment after surgery, so we need to make sure that form are completed correctly.

  4. Lack of Major psychiatric diagnosis.

  5. Surgical clearance by internist in patients older than 50 years old or in patients with known cardiovascular /pulmonary disorders.

    Exclusion criteria

  6. Patient is not able to localize the starting point of migraine attacks.

  7. Medication overuse headache. This needs to be ruled out by the neurologist and if the patient is in medication overuse cycle, he/she needs to be detoxed and be OFF medication overuse, at least 3 months prior to surgery.
  8. Patient who are on opioid medication, even for any reason other than headache. These patients
    could become a candidate after being treated by drug dependency specialist and being opioid free for 3 months
  9. Significant comorbidities.

    After receiving the referrals through the IHA, patient will fill out the pre‐treatment questionnaire and if they qualified based on the questionnaire, they will proceed with completing the 4‐6 weeks of the headache log.

    At the end of 4‐6 weeks, patients will be interviewed through Skype or FaceTime by either Prof.Guyuron or Dr.Totonchi to discuss the potential surgical benefit and plan and to answer patients’ questions .

Dr. Hossein Ansari