For those living with migraine, the intense, pounding pain can be crippling. They’ll do anything to get rid of it. From taking pills to seeking alternative cure, to hammering their head against the wall, a person with migraine will try it all.
A report in a leading newspaper has then portrayed surgery as a new and effective way to “treat migraine.” The report quotes a study done by maxillofacial (face, mouth and jaws) surgeons from AIIMS Delhi and Srinagar Military Hospital.
But neurologists The Quint spoke with say surgery is an absolute last resort for extremely severe cases. They also question how the study was conducted.
Dr Anshu Rohatgi, Senior Consultant, Neurology, at Sir Ganga Ram Hospital, says the report paints a very simplistic picture, while migraine very complex.
What Does the Study Say?
According to The Times of India report, the study concludes that “it makes sense to go under the knife to get rid of migraine.”
Dr Anson Jose, from Srinagar’s Military Hospital, led the study.
The report read:
With surgery, 14 out of 30 patients reported complete elimination of migraine after a year and an equal number reported significant relief of symptoms one year after the procedure. Only two patients failed to notice any significant improvement.
The surgery involved the removal of muscles that are believed to trigger migraine attacks by compressing the neighbouring nerves.
Dr Ajoy Roychoudhary from AIIMS was quoted as saying that this surgical removal provides long-term relief compared to the medicines which have “known side-effects.” He did caution that surgery may not be a solution for all.
What Neurologists Have to Say About the Study
Neurologists say that this study has been “overplayed and blown out of proportion.” And that there are very little details explaining the nature of the study.
Addressing what has been reported, Dr Rohatgi said it’s amusing to see how a migraine study didn’t involve any neurologists and that raises a serious question mark.
We don’t know what kind of migraine did the patients have, common or chronic, how severe were the cases, what medication they were taking and unfortunately from what the reports say, there was no neurologist involved in the study.Dr Anshu Rohatgi, Senior Consultant, Neurology, Sir Ganga Ram
He says this lack of information makes it very difficult to draw any inferences from such a small study. And a short term follow-up will not work, it has to be studied over a longer time and the data has to be controlled.
Dr Manjari Tripathi, Professor, Neurology, AIIMS Delhi, distanced herself and her department from the study.
It hasn’t been conducted in our department. It has been done in the dental department. In fact, we don’t know which doctors from AIIMS were involved. Dr Roychoudhury hasn’t done the study. He seems to have just commented on something done by another centre. I’m not aware of any trial in my department.Dr Manjari Tripathi, Professor, Neurology, AIIMS Delhi
Dr JD Mukherji, Senior Director and Head, Neurology, Max Hosptial Saket, added that research on migraine surgeries is not new and has been going on across the globe for 15-20 years.
Who Should Go For Migraine Surgery?
Making surgery sound like the go-to option to “treat” migraine is problematic, the neurologists say.
When every other line of treatment fails, only then does surgery come into the picture and that too only for severe chronic cases. Dr Mukherji says that the number of patients who would reach the stage of surgery is miniscule.
There are two surgeries which have been approved by the US FDA (Food and Drug Administration); the Greater Occipital Nerve Entrapment and Supraorbital Nerve Surgery, both of which are for relieving the pain.
Only these two are approved, you can’t just go and operate anywhere. Even I have migraine, I get it once or twice a month. I can’t just go and get operated, that’s not how it works.Dr Manjari Tripathi
“It’s done in very severe patients who aren’t responding to medication or who are on several painkillers and migraine medicines which are producing side effects,” she explains.
Does Surgery Work?
Dr Manjari Tripathi adds that these surgeries are not 100%, and they may reduce frequency and severity to some extent, not “treat” it.
As far as neurologists are concerned, we’re not convinced. It may work for individual cases but I would not recommend it to patients. Surgery also has its side effects.Dr Anshu Rohatgi, Sir Ganga Ram Hospital
I would not like to remove someone’s muscle if it can be controlled by other means.Dr JD Mukherji, Max Hospital Saket
What Are the Other Treatment Options?
Dr Mukherji explains the various options there are to manage migraine, in order of their usage. It is when all of these fail, that based on the patient’s case, surgery may be suggested. But it is extremely rare.
- Non-pharmacological methods: this includes yoga, meditation and avoidance of triggers.
- Preventive medications.
- Instruments like Cephaly, which is an FDA approved tool which uses electrical stimulation.
- For chronic cases, botox injections when none of the above works.
All the neurologists say that surgery is absolutely the last resort.
What Do Patients Say?
Deepak Jha, an HR professional, suffered from severe chronic migraine for years. He’s undergone every single treatment, from medication to botox to alternative cures. he says his pain was so severe he lost out on jobs and found it difficult to function. He opted for surgery twice. Once in 2007 in Dubai and again in 2012 in Delhi.
The surgery did help in reducing the intensity and frequnecy of the pain. But it’s not a cure in any way. I still get migraines. And in fact, if I’m being honest, meditation was actually what helped me in the end.
The surgery was absolutely the last option for him. And he as well as the doctors say that you should consult your neurologist and follow the course of action they suggest.
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