For someone who suffers from migraines, the pain of the headache is bad enough, and the dread that one may be coming on can be even worse.
Dr. Bahman Guyuron, a Cleveland plastic surgeon associated with the American Migraine Center and a pioneer in the surgical treatment of migraines, offered HealthScene Ohio his expertise on this fearsome class of headache.
HealthScene Ohio: What got you interested in the field of migraine study?
Dr. Bahman Guyuron: Two patients who had undergone forehead lift reported that they no longer had migraine headaches after the surgery.
I did a retrospective study on 314 patients who had undergone forehead lift, and 31 of the 39 patients who had migraine headaches preoperatively experienced either complete elimination or significant improvement of migraine headaches with close to average four-year follow up. This prompted me to conduct several prospective studies, including a pilot study, randomized with control, randomized with sham surgery and randomized study with five-year follow-up.
All in all, we have completed 27 studies, and all of them have been published in peer-reviewed journals, demonstrating the efficacy and safety of surgical treatment of migraine headaches.
HSO: What do patients most want to accomplish when they see you?
BG: They want to reduce or eliminate the headaches and gain control of their lives.
HSO: What are some barriers to meeting patients’ expectations?
BG: The complexity of migraine headaches and the fact that, in rare cases, patients have many migraine trigger sites can be barriers. Additionally, when the patients are dependent on narcotics, it is hard to be sure whether the persistent pain is related to the residual migraine or patients’ need for narcotics.
HSO: What are some new things you are trying out to help your patients with migraines?
BG: We are simplifying the procedures so that most of them can be done under local anesthesia, and patients can return to work the same day or the next day.
HSO: What have been some of your most successful tactics or treatment methods?
BG: Migraine surgery is all about deactivation of the migraine trigger site. Employing ultrasound Doppler and CT imaging has enabled us to more accurately detect and stop the triggers.
HSO: What are some of the anxieties patients have when they come to see you? How do you try to remedy that?
BG: Surgery is always a frightening prospect for patients, and there is a great deal of anxiety about potential failure. For many of these patients, this is a desperate last hope.
We reduce the anxiety by showing understanding and compassion, offering realistic assurance, and by letting the patient know that with the surgery there is always a plan B, C, and even D should plan A fail.
HSO: How do you work with the patient to reach his or her goals?
BG: It is important to have the patient’s utmost cooperation in describing symptoms accurately; recording his or her headaches in detailed logs; using every tool effectively to detect the trigger sites; avoiding drug-overdose headaches; and avoiding or minimizing the use of narcotics. It’s also important to the patient’s full cooperation postoperatively to deliver a successful surgical outcome.
HSO: What is some exciting research in the field of migraine study today?
BG: We are working on the use of stem cells to try to repair the myelin deficiency in the axons that the patients with migraine headaches have inherited, as demonstrated through our studies at Case Western Reserve University in cooperation with the proteomics and neurobiology departments.
HSO: What’s the difference between a headache and a migraine?
BG: Most headaches are essentially part of the same spectrum. The mild, non-migraine headaches are related to the peripheral nerve irritation without central involvement. Migraine headaches are associated with central nervous system symptoms such as nausea, vomiting, photophobia, and phonophobia.
HSO: How can someone pinpoint the cause of his or her migraine?
BG: By listening to the patients explain where the headaches start, along with a constellation of symptoms that we have described and reported. I also use ultrasound Doppler and CT imaging of the peri-nasal sinuses to pinpoint migraine trigger sites.
HSO: Under what circumstances should you visit your doctor? What symptoms are the most worrisome?
BG: Whenever the symptoms cannot be controlled with conventional migraine medications, when there is potential for dehydration because of persistent vomiting, when side effects of the medications make their use unwise or impossible, it is time to visit the doctor.
HSO: Are there any lifestyle changes that can help with headache/migraine relief?
BG: Not with surgery. If the surgery is going to work, patients should not have to change their lifestyles. Medical treatments may require avoidance of usual triggers.
HSO: What is the most effective way to treat a migraine?
BG: Most migraine headaches respond to the triptans. There are newer medications on the horizon as well. However, for those who have frequent migraine headaches and do not respond to medical treatments, or do not wish to or cannot consume migraine medications, surgery becomes a great choice.
HSO: What are spinal headaches?
BG: Spinal headaches are the consequence of spinal fluid leak as a result of injury, surgery or spinal tap.
David Allen is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Dr. Bahman Guyuron is a graduate of Tehran University Medical School. He completed a residency in general surgery at Boston University in 1978 and a residency in plastic surgery at the Cleveland Clinic Foundation in 1980. Dr. Guyuron also completed a fellowship in craniofacial surgery at Toronto University Hospital for Sick Children in 1980. He is certified by the American Board of Surgery and the American Board of Plastic Surgery. He has been in private practice since 2015, has previously practiced at the Cleveland Clinic Foundation, Mt. Sinai Medical Center and University Hospital Case Medical Center and Case School of Medicine, where he still holds the title of emeritus professor. Dr. Guyuron has developed an international reputation for his innovations in rhinoplasty and facial aesthetic surgery and has more than 40 peer-reviewed publications on the surgical treatment of migraine headaches.
