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  1. Dr. Hall
    16 September 2014 @ 7:41 pm

    James – I appreciate your comments, and agree with you. I’d actually raise you one…surgery is not a treatment for migraine.
    The condition I’d argue surgery is beneficial for is for patients who have a missed diagnosis of nerve compression headaches. In my practice, it is not uncommon to have patients who come in with “chronic migraine” or some other migraine variant who, in actuality, have headaches due to nerve compression (commonly, occipital or supraorbital neuralgia). This condition is diagnosed by history (talking to a patient) and physical examination, and responds very well to surgical nerve decompression. So – do I “cure” their migraines? No. They don’t have migraine from the start, but are misdiagnosed because the diagnostic criteria for migraine are unclear. According to the ICHD criteria, migraine should be, essentially, a diagnosis of exclusion – everything, including nerve compression syndromes – should be ruled out before labeling someone a migraineur. Unfortunately, this is usually not the case, and is, in my opinion, at the heart of this debate.
    The inflammatory article you review is written by two gentlemen who are both extremely biased and who have significant financial conflicts of interest when it comes to this discussion (Diener alone is a paid spokesman and researcher for at least 20 different drug manufacturers, most of whom make millions annually off of migraine drugs). Your readers need to keep this in mind when reading the opinions expressed in his article.
    Thank you for bringing this to the attention of your readers, and for your insightful comments on the article.

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  2. Sharon Dunne
    23 November 2014 @ 11:31 am

    Diener and Bingel’s “thoughts” are necessarily skewed by the sums they are paid as “researchers” and consultants to drug companies. These are mentioned at the end of their article. I was astonished to learn recently that some neurologists in the UK are paid £30,000 a year by Pfizer to “consult and research”. The only training historically given to neurology students on treatment of migraine, for decades, was drug treatment. They have no real authority to comment on surgical intervention but they feel free to write it off and would aim to block its availability.
    I would agree with the other comment on this article that many “migraines” are in fact headache with multiple contributory factors and the physical involvement of nerves is often not understood or given adequate consideration.
    I underwent decompression surgery of the corrugator muscle in 2009 (in Berlin) after the appropriate testing showed 90%+ improvement in pain levels and medication reduction. This allowed me a full professional working life for the following 3 years.
    Over the last 2 years the headaches worsened again, possibly related to an episode of viral meningitis, possibly down to increased academic workload causing neck issues.
    I went through the usual plethora of neurology appointments, drugs (both prophylactic and pain relievers) to little effect. Due to the fact that my diagnosed “severe, episodic migraines” were keeping me in bed only 7 or 8 days a month I did not qualify for botox treatment on the nhs.
    Three months ago, after a severe rebound headache following an unsuccessful bilateral occipital nerve block I returned to the German surgeon from Berlin. His botox test into my neck produced similarly effective results to the first test years before.
    I have recently returned from Berlin after surgery to decompress nerves in my neck and close arteries at my temples. I did not enter into these operations lightly; but because it could be demonstrated by a simple test that the effects would be excellent.
    I know that I have experience pro and post-drome migraine symptoms, occasional visual aura, speech difficulties with “migraine”, gastric symptoms, occasional vomiting through pain, sensitivity to sound and smells and so on. I also have clear indicators of cervicogenic headache, which are all but ignored by the neurologists I have seen (with the exception of the pain team at St Thomas’s hospital).
    I think that it is likely that many things contribute to my severe headaches but the pain level is sufficient for complete disablement and an inability to perform any activities of daily living and to be confined to bed. At seven days off work a month I could not continue.
    Migraine surgery enabled me to have several years of productive working and functioning family life. Whilst not “life threatening” this condition leaves hundreds of UK residents confined to their homes for the majority of their lives, unable to perform the simplest of tasks and reliant on benefits. Online communities are full of thousands of despairing sufferers limping through life trying to hold onto jobs they are at risk of losing and care for families who do not understand the issues fully.
    Neurologists, well meaning or otherwise, could not give me the ability to go back to work. Their drugs caused me to become zombie – like and despairing.
    It should not be biased doctors (of whatever specialty) who make the decision on whether this surgery should be continued to be offered. Proper research, not funded or designed by drug companies, is sorely needed in this area.

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