Cosmetic surgery could mean relief for migraines

Releasing pressure on nerves around the head may alleviate chronic discomfort

Bryan Kirsch knew something was wrong when the stairs moved.

After roughhousing with his children in 2011, he was walking upstairs with one when, he remembered, “I look up the stairs, and the whole world is spinning.”

So began three years of near-constant pain from migraines.

Kirsch is one of the first people in Chicago to undergo a surgery aiming to alleviate chronic migraine pain.

Now, Kirsch says, he is essentially free of pain.

“I couldn’t have sat out here,” he said as an elevated train rumbled and roared overhead. “It’s been night and day for me.” Cleveland, Ohio, plastic surgeon Bahman Guyuron, who has trained about 50 doctors across the nation to perform this surgery, said he discovered a correlation by chance in 1999. He noticed that, among his patients, people with cosmetic forehead lifts also noted migraines ebbing.

“I thought that that was just a coincidence,” said Guyuron, emeritus professor of plastic surgery at Case Western Reserve University School of Medicine.

“A couple of weeks later, another patient told me the same thing.”

Some doctors say certain types of chronic migraine headaches can be caused by nerve compression.

Surgery can release the pressure on the nerve from surrounding tissue like muscle, which can then alleviate pain.

After nearly two decades and 24 studies by Guyuron’s team, doctors are working to get health insurance companies to recognize and cover the surgery — as well as build awareness about a procedure they say can alleviate debilitating head pain.

Guyuron says studies show as high as a 92-per-cent success rate for the surgery. A 2011 article in the Journal of the American Society of Plastic Surgeons tracked patients five years after undergoing it. It showed 61 of 69 patients reported improvement, and 29 per cent reported a complete elimination of migraines.

Dr. Elizabeth Loder, chief of the Division of Headache and Pain at Brigham and Women’s Hospital in Boston, said migraines naturally wax and wane, making it difficult to tell whether change is due to a solution or simply time.

Loder is former president of the American Headache Society, which, in 2013, cautioned against this type of surgery outside of a clinical trial.

Clinical trials are strictly controlled, and Loder said data with long-term followups and a randomized, larger number of patients would amp up the research base.

So far, the database does not include as many patients as Loder would like, and she said it could benefit from measuring people who did and did not receive surgery. Also, the different pain locations make it difficult to study patients equally, she said.

“I think we do need additional trials, ideally done by people who are not invested in the outcomes,” she said. The procedure involves making small incisions, then releasing nerve pressure.

Kirsch, 37, left the hospital the same day.

“The rest of my life’s back to normal,” he said. “Relief was almost instantaneous.”

Kirsch’s surgery was not covered by health insurance. Although the cost was not small, he said it was a nobrainer if it meant being present at his kids’ birthday parties.

“My wife and I never even debated,” he said.