Talk:Migraine surgery

Concerns
"Migraine Surgery"

This entire entry is essentially an advertisement for a particular and very controversial surgery offered by one dentist in South Africa. It is not at all an objective discussion of the facts around migraine and the efficacy of surgery. There may well be some merit in some parts of the discussion, but the article makes no effort to reflect the absolutely key fact that this surgery is practiced nowhere in the world other than a provincial clinic in South Africa. That the clinic behind this entry has targeted a Wikipedia entry in this way is very revealing about its modus operandi and how far it stands from the accepted conventions of objective scholarship. Caltech1972 (talk) 14:57, 21 September 2012 (UTC)
 * Agree which is why it is tagged with a NPOV tag. I guess the question is do we need to figure out if there are any secondary sources supporting the content and delete the rest. Feel free to begin if you wish. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:12, 21 September 2012 (UTC)


 * -Agreed, researched the info on this page and have consulted multiple neurologists on this so called 'surgery.' It does not exist anywhere in the world but for that one practice in Africa. Nothing but an advertisement and false hope for migraine sufferers. — Preceding unsigned comment added by 75.152.124.249 (talk) 00:55, 23 October 2012 (UTC)


 * Agreed. The introduction reveals a clear conflict of interest, not to mention a sub-heading that is phrased as follows: "How do we diagnose who will benefit from arterial surgery?"--Jamesneilanderson (talk) 11:31, 1 January 2013 (UTC)

"Toxic Circulation"
This page says a whole lot of very non useful things. The one that stood out above: toxic ciruclation. Im pretty sure that without adequate sourcing, we should label these things (and toxic circulation especially) as being meaningless pseudo-science. Id love to see this article grow, but the second warning flag is 15 citations for a single thing. Overcompensating for lack of evidence by showing a large amount of a lack of evidence isnt exactly winning me over.

The emphasis on Botox is rather alarming as well. It doesnt seem to be emphasized that its suggesting we inject botulism into our heads. That seems like the sort of thing that needs way better citations than a dozen abstracts. 74.128.56.194 (talk) 06:31, 19 June 2011 (UTC)

I would like to address the above concerns:

With regard to toxic circulation, I agree with the writer that it seems like meaningless pseudoscience, but it clearly states that it is only a theory - I think that as long as that caveat is made, then it is a valid contribution.

The fifteen references are all from peer reviewed internationally accepted medical journals. The reason for the apparent overkill is that it is the subject of intense debate in the headache world. This evidence has however been summed up in a recent review article published in headache, and the 15 could easily be substituted fro one reference.

Botox is injected into peoples heads thousands of times every day, but that does not mean that we are injecting botulism, wich can be fatal. The botox has been altered chemically and can not and has never caused botulism.

Can I please discuss these issues, so that we can get the problems removed?

Botox
It is inappropriate to have a section on Botox on the 'Migraine Surgery' page. Administration of Botox is not a surgical procedure. This should be moved to the 'Migraine' page — Preceding unsigned comment added by 11943e (talk • contribs) 14:39, 5 December 2011 (UTC)

Does Migraine Surgery Work?
I'd like to address several of the points brought up in other contributions to the Talk Page for Migraine Surgery

1. It is not at all correct that surgery is only offered by a dentist in South Africa. Professor Muhelberger offers it in London and Germany and there are several surgeons in the USA 2. I agree with the principle of evidence based medicine and with any new subject it takes time before the evidence is accepted by all. However more and more evidence is confirming that surgery can be effective. This is one of the most comprehensive investigations by Dr Guyuron, one of the most experienced surgeons Guyuron B, Kriegler JS, Davis J, Amini SB. Five-year outcome of surgical treatment of migraine headaches. Plast Reconstr Surg. 2011;127:603-8 Here's a link - http://www.migrainesurgery.co.uk/uk/assets/downloads/international_publications/Five_Year_Outcome_of_Surgical_Treatment_of.14.pdf 3. Botox is well worth a mention in relation to Migraine surgery as it is used as a diagnostic indicator as to whether surgery will be effective Janis JE, Dhanik A, Howard JH. Validation of the peripheral trigger point theory of migraine headaches: single-surgeon experience using botulinum toxin and surgical decompression. Plast Reconstr Surg. 2011;12:123-31. Here's a link - http://www.migrainesurgery.co.uk/uk/assets/downloads/international_publications/Validation_of_the_Peripheral_Trigger_Point_Theory-1.20.pdf

On the more general point of why there are so many types of surgery (and non surgical treatments) offered for migraines perhaps it would be useful to have a quick overview of how migraines start. This is something I wrote earlier....

Anybody who suffers from migraine headaches will know how debilitating they can be. Most treatments presently used are limited in their effect, and the misery and expense through days lost at work can be enormous. The causes of Migraines are complicated, but new research is changing doctors’ understanding of how the attacks start, resulting in the potential of a permanent cure for a common group of migraine sufferers.

What Is A Migraine? Simply put, Migraines are caused by a misfiring of the nervous system. There is an overwhelming build-up of nerve cell activity in the brain stem at the base of the brain and the effect of this spreads in a cascade to produce the migraine headache that lasts for several hours to a day or more before it gradually recedes. The misfiring can spread to other parts of the brain to produce visual distortions, pins and needles in the face and strange tastes before the headache starts. Some sufferers may recognise that they are building up to an attack days before it starts. Different sufferers have many different patterns of symptoms and this has produced a plethora of competing theories, and treatments, and has lead to a degree of competition between some doctors who believe that they have the better explanation/treatment. The reality is that they are all right, or at least partially so!

Trigger Zones It has been recognised for years that Migraine sufferers have trigger zones, the most common ones being at the back of the head, over the eyes, and over the temples. These correlate to the distribution of the Occipital Nerve and the Ophthalmic Branch of the Trigeminal Nerve. Interestingly both these nerves have their roots in the same part of the brain, where migraines start, and they carry not just ordinary sensory fibres of touch and pain etc but also fibres of the sympathetic nervous system, a more primitive system that controls many body functions such as breathing and blood pressure. The intimate linking of the two apparently separate nerves covering different areas is illustrated in some people who are aware of sensations above their eye when the back of their neck is pressed. As it happens, both these points are also acupuncture points. Occipital Nerve blocks have been used at the back of the head for many years, with varying success, and dentists have talked about the TemporoMandibular Jaw joint being a cause of migraines, and treated jaw misalignments, again with varying success.

Seeing Inside The Brain More recently a special brain scan called a Functional MRI Scan has enabled doctors to visualise the brain activity as a migraine is actually happening and you can see the build-up of nerve cell activity as the migraine occurs. More specifically, for those who have a well define trigger zone over one eye you can see that the ophthalmic branch of the Trigeminal Nerve is thickened as it comes out from behind your eye over the bone and up on to your forehead. This is the place that sufferers press to relieve the headache in a migraine attack, though in reality pressing there works in part by distracting you from the migraine because it is so unpleasant to do, even when you're not having an attack!!

Published medical research from America and Germany has described how specially placed Muscle-Relaxing injections of Botulinum in true migraine sufferers can result in a 50% reduction in intensity and frequency for up to 85% of those injected, with up to 50% having no attacks at all for several months, after which the treatment can be repeated. Even allowing for a degree of unintentional selection of patients in these studies the results are remarkable. Overall it appears that at least 50% of all migraine sufferers are helped partly or totally by Botulinum. It is possible to assess before the treatment who is most likely to benefit, so the success rate after selection is much higher. Even so, most medical specialists treating migraines in the UK have not yet caught up with these latest developments and many sufferers are not being told of such an effective treatment through ignorance.

The reasons why the Botulinum can be so effective are still being researched, but it appears to work by relaxing the muscles where the migraines start. It has been know for years that many people's migraines start with spasm of muscles at trigger points, most commonly the eyebrows, temples or back of the head. This spasm mechanically stimulates the nerves at these trigger points which then send unwanted information back to a particular area in the base of the brain where the migraines build up. Indeed the muscular spasm in some people can be so marked that their eyebrows become raised and prominent. A cascade of hyperstimulation starts that both increases the spasm at the trigger points and spreads to other areas to produce the visual and other sensory auras as well as the intense headache. Botulinum relaxes the muscles at the trigger points and stops the circle of overstimulation before it starts.

Indeed these researchers have also discovered that Botulinum is both an effective treatment in its own right and is also a very effective diagnostic indicator to the effectiveness of surgery to the muscles at the trigger point to permanently prevent the spasm and decompress the nerve, since almost 100% of those who respond well to Botulinum also respond equally well to surgery.

Chrisblatchley (talk) 16:25, 31 December 2012 (UTC)


 * The part about trigger release is valid with multiple studies from Cleveland and Dallas to prove it . The part about arterial surgery is likely written by Dr Shevel and is an advertisment and has no scientific Merritt . I ask Wikipedia to remove it please . — Preceding unsigned comment added by 99.126.224.82 (talk) 04:02, 31 January 2013 (UTC)


 * There is no need for a disquisition on migraine.


 * First, Guyuron's nerve decompression sugery (essentially removing muscle from around a nerve) is, despite some anecdotal success, unproven and is not accepted by the American Academy of Neurology as a migraine/headache treatment. Most of those offering this type of surgery are plastic surgeons; few neurologists recommend it.


 * Second, Shevel's headache procedure, which is advertised in this entry, is different. It involves ligating branches of the external carotid artery and 'cauterisation' of muscles. This surgery is only offered in his clinics in South Africa. It is not nerve decompression surgery.


 * The point remains: this wikapedia entry for migraine surgery is an entirely biased advertorial for one cline. — Preceding unsigned comment added by 188.141.23.166 (talk • contribs)

Removed background information from lede
I removed the following information from the lede. This information and these citations should be elsewhere, either in the body of this article or probably in migraine. It does not belong here in long form. I am putting it here for storage in case anyone disagrees.

Migraines affect an estimated 10% of the worldwide population annually and cause significant loss of workdays and billions of dollars in productivity. It is well documented that migraine headaches cause significant disability, and reduce of quality of life that is as dire, if not worse than, debilitating chronic diseases. There have been major pharmacological advances for the treatment of migraine headaches, yet patients must still endure symptoms until the medications take effect. Furthermore, often they still experience a poor quality of life despite an aggressive regimen of pharmacotherapy.

 Blue Rasberry   (talk)   20:41, 26 December 2013 (UTC)

Procedure not defined, one kind of surgery never indicated
This article does not clearly define what migraine surgery is. I am unsure if this is one kind of treatment or just a general term for many types of procedurally unrelated surgeries which only have treatment of migraine in common. In any case, the American Headache Society has advised that "surgical deactivation of migraine trigger points" not happen outside of clinical research, and I created an indications section in this article saying as much. Per WP:MEDMOS, Wikipedia articles on treatments should have an indications section. If anyone has sources describing when this surgery is indicated then please share. It seems like there is weak sourcing in this article surrounding many aspects of migraine surgery.  Blue Rasberry   (talk)   20:58, 26 December 2013 (UTC)

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