In Six-Month Review After 2014 Migraine Surgery Symposium, Dr. Bardia Amirlak and Others Report Improved Patient Selection Criteria

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In a six-month review of results from the 2014 symposium on migraine surgery, Dr. Bardia Amirlak and participating doctors report improvement in patient selection criteria. In their report, the doctors urge colleagues to continue acting on symposium findings.

Migraine surgery: Dr. Bardia Amirlak demonstrates endoscopic decompression of nerves, a new technique to relieve pain in desperate migraine patients.

Dr. Bardia Amirlak demonstrates endoscopic nerve decompression during migraine surgery.

An unfortunate 37 million Americans suffer from migraine headaches and desperately seek invasive treatment after conservative measures have proved futile.

Six months after participating in the 8th Annual Symposium on the Surgical Treatment of Migraine Headaches in Cleveland, Ohio, Dr. Bardia Amirlak released a review showing high-volume migraine surgery clinics are using new patient criteria based on information shared at the symposium. In the review, Dr. Amirlak, Medical Director of the Plastic Surgery Clinic at the University of Texas Department of Plastic Surgery in Dallas, Texas, and director of Peripheral Nerve Surgery at the VA North Texas Health Care System, said criteria changes are leading to greater success and positively impacting lives of patients who suffer debilitating migraine headaches. Dr. Amirlak said he and others believe advancements like this are a direct result of such symposiums and other methods emphasizing sharing of information among expert providers.

The symposium was held in November of 2014 at the Case Western Reserve University School of Medicine. It was hosted by world-renowned plastic surgeon, Dr. Bahman Guyuron, former chairman of the Case Western Reserve University Plastic Surgery Department and the leading innovator in migraine surgery, in collaboration with Dr. Deborah Reed, neurologist and leading expert in the field of migraine headaches and migraine surgery. During facial cosmetic procedures, Dr Guyuron first made the ground breaking discovery that nerve decompression helps migraines, and he later perfected the procedure.

The symposium served not only to teach other surgeons and neurologists, but provided a forum for discussion of new developments related to surgical treatments for migraines.

Thirty-seven million Americans suffer from migraine headaches and desperately seek invasive treatment after conservative measures have proved futile. In recent years, surgical management of migraine headaches has gained attention through the introduction of revolutionary techniques with excellent results. In addition, there has been a healthy amount of peer-reviewed, evidenced-based literature and anecdotal substantiation supporting the success of migraine surgery. However, despite these advances, there is an ongoing debate among neurologists regarding the efficacy of migraine surgery and absence of regulatory control needed for the qualification of migraine surgeons and the process of patient selection by neurologists.

The recent trend toward advanced selection criteria to ensure better outcomes in migraine surgery is seen as evidence of steps in the right direction. Dr. Amirlak urges novice migraine surgeons to review results of the 2014 symposium, avoid calling this procedure “the cure,” and begin thinking about ways to collaborate with each other and other neurologists. “Prior to offering the surgery, one has to feel comfortable with the proper patient evaluation and technical details of the surgery,” Dr. Amirlak said.

The migraine surgery panel session at the symposium was moderated by Dr. Jeff Janis, Professor of Plastic Surgery at The Ohio State University Wexner Medical Center. During the panel discussion, the migraine experts shared innovative techniques and discussed their potential for future migraine surgery treatment:

  •     Dr. Guyuron discussed the use of a Doppler probe to identify the locations of trigger sites in vessels that could be causing nerve compression.
  •     Dr. Amirlak introduced a modified endoscopic occipital nerve decompression technique allowing for the identification of pulsatile compression points by the artery.
  •     Dr. Moore, private practice migraine specialist and director of Midwest Migraine Surgery Center, discussed his success using an innovative modified open approach through the eyebrow
  •     Dr. Hagan, private practice migraine specialist and director of the Neuropax Clinic in St. Louis, Missouri, detailed his successful experience with surgical decompression for patients suffering from headaches secondary to whiplash injury.
  •     Dr. Totonchi, Assistant Professor of Plastic Surgery at Case Western Reserve University School of Medicine, talked about optimal candidates for surgery. His talk reflected the comments of Dr. Hossein Ansari, neurologist and medical director of The Headache Center at NNA (Neurology & Neuroscience Associates, Inc.), who delivered a lecture on the risks of medication overuse and patient selection.
  •     Dr. Stepnick discussed the use of an endoscope to aid in nasal septal surgery in migraine patients.

It is in the area of patient selection that Dr. Totonchi, Dr. Amirlak and others have seen significant adjustments based on information shared at the symposium. In regard to his own practice, Dr. Amirlak said, "Since the meeting, we have imposed stricter selection guidelines, and we are carefully looking at the impact of medication overuse and severe depression on surgery results." He said most of the high volume migraine surgery centers in the U.S., such as those in Dallas, Texas, and Cleveland, Ohio, have adopted stricter criteria since the symposium and doctors continue to collaborate with each other on difficult cases.

"Personally, I am using a constellation of symptoms, BOTOX and nerve blocks to identify the correct triggers in migraine patients, but we routinely treat other headache disorders with nerve decompression, including new daily persistent headaches (NDPH) and occipital neuralgia,” said Dr. Amirlak.

“These surgeries have the ability to transform patients' lives,” Dr. Guyuron said, “and the testimonials we’ve seen from patients all over the country are a catalyst and driving force for the advancement of knowledge in this rapidly expanding field.”

For more information about migraine surgery please email Headachesurgery(at)gmail(dot)com.

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Ronnie Pezeshk, M.D.
Migraine Surgery Treatment
+1 4029683528
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