headache surgery

22 April 2024

Occipital Nerve Stimulation for Cluster – Why does it “sometimes” work?

When we first discussed occipital nerve stimulation back in 2007, the results were promising, but not consistent. Now that’s not unusual for an early study. But when it comes to conditions like cluster headache, there’s another problem.

Occipital Nerve Stimulation results are varied!

Cluster headache is certainly a rarer type of headache disorder. So when you have fewer people experiencing it, you’ll also have fewer trying a specific treatment, and fewer people in clinical trials. So it takes a long time to get results – and those results may be less reliable than they would be with a larger group.

Occipital nerve stimulation remains a promising treatment today, and also a treatment that doesn’t work consistently. That fact was brought to the attention of researchers in the Netherlands, who published a study last year entitled “The Untold Story of Occipital Nerve Stimulation in Patients With Cluster Headache: Surgical Technique in Relation to Clinical Efficacy”. In their report, they included the above statistic for “efficacy” (usefulness – success) of the treatment – 35.7% to 90%! Quite a variation.

Occipital nerve stimulation involves implanting a small device surgically. The device provides “neurostimulation” for the occipital nerves. As this report points out, “the physician aims to target all the occipital nerve branches simultaneously”. The stimulation seems to interrupt pain signals, providing pain relief.

So why doesn’t it consistently “work as advertised”? The researchers found two variables. The first one is – you! The exact makeup of your body is not the same as someone else’s. You can’t just cut someone open and find the exact same nerves in the exact same place.

Now, of course, your surgeon is aware of this. But there’s only so much that a doctor can do.

One thing they can do it standardize surgical techniques. If all doctors, for example, measured in the same way when they implanted the device, we would at least have a more similar treatment.

But that’s not what’s happening. Doctors may use significantly different methods, and also record different information. That means that we can’t even properly compare clinical trials, because we can’t compare exactly what the doctor did.

These researchers are recommending certain points of standardization so that we can properly compare results. This may mean that doctors try to find the best technique based on the current research, and go with that. But it also may mean different techniques that are measured and reported in a standardized way, so that results can be better compared.

When looking for a surgeon, it would be helpful to know what the success rate of this treatment is for their patients. But it also would be nice to know what standards they are following.

This is not just a concern in cluster headache surgery, but in many types of treatment. Though we wouldn’t want to restrict doctors from the treatment they feel is best for you, we also want to make the most of each treatment, so that everyone can improve.

12 February 2024

Cryoneurolysis Treatment for Headache?

James Discoveries & Stats 0

Cryoneurolysis is a treatment that has been used for chronic pain, but what about headache?

You may have already guessed from the prefix “cryo” that this has something to do with cold, and you’re right. In this case, it’s extreme cold – we’re not talking about ice packs.

When we use cryoneurolysis to treat pain, it’s called cryoanalgesia. There are other applications, but that’s the one that’s important to us at the moment..

Cryoneurolysis involves inserting a probe (a “cryoprobe” – no kidding) into the body to apply extreme cold to a speficic area, usually nerve tissue. The cold breaks up some of the tissue, interrupting the pain signals that are carried by the nerve. The nerve will actually regenerate over time, making this a temporary procedure – although at times the regeneration may improve your symptoms.

Now we know that for many types of headache, simply cutting off a certain pain signal from a certain nerve isn’t the answer, and may cause more problems than it solves. However, when we have a more specific understanding of where the pain is coming from, this may be a useful procedure, although it isn’t widespread yet (for headache conditions).

When you see the word “neuralgia” – a certain kind of nerve pain – that’s a clue that this type of treatment might be useful. Patients have received surgery for occipital neuralgia, for example, a certain kind of head pain from certain nerves. This 2021 study is an example of the work that’s being done for this type of condition.

Trigeminal neuralgia is another example. A study is starting in Norway to investigate the usefulness of cryoneurolysis for this very painful condition.

Cryoneurolysis has its drawbacks, which we’ve already mentioned. Its use for headache is not widespread. But it also tends to be unpredictable in its duration. How long will the pain relief be? That may vary quite a bit. And it is still a surgery.

However, researchers continue to investigate because it’s a relatively easy procedure, with few side effects. If it’s found to be useful, it can also be a very cost-effective treatment. And although the duration of relief may be unpredictable, it can last for a long time in some patients – much longer than the pills people are taking that only last a few hours at best.

For a technical overview of some of the other uses of cryoanalgesia besides headache, check out The applications of cryoneurolysis for acute and chronic pain management from 2023. For a more user-friendly summery, read Freezing Nerves, An Effective Way To Treat Chronic Pain.

12 January 2019

Nasal Surgery for Chronic Headache?

James Discoveries & Stats 0

A recent meta study showed that many patients are experiencing significant improvement after certain types of nasal surgeries. But read on for details before you rush out to get the surgery done yourself.

The study was published last month in Plastic and Reconstructive Surgery. Researchers collected 39 studies, reporting on 1,577 patients who specifically had functional nasal surgery for chronic headaches. The purpose of this type of surgery is basically to improve the “function” of nasal pathways by enlarging pathways.

First, the good news. Many patients did improve – some even considered themselves “cured” of chronic headaches after the procedure. We’ll get to the details later.

But note that these were patients who had surgery specifically for chronic headaches. And that means that the patients were people who doctors felt would benefit from this surgery for specific reasons.

What would those reasons be? One example would be to treat a deviated septum. A deviated septum is actually pretty common – but it is unlikely to be the cause of your chronic headaches. However, there are ways that your doctor can check (without surgery). A major hint is when the headaches occur on the side toward which the septum deviates. The doctor can use an anaesthetic to see if she can relieve the headache. More info here – Is a Deviated Septum giving you a headache?

Another example – clearing the pathways of excessive sinus tissue. There are actually a few reasons why you may have a partial blockage – and again, this is something your doctor can check.

Some patients had other problems that tipped them off – such as recurring sinus infections.

So now you’ll understand the statistics a little better. These are not random patients, but patients that had a specific need for the surgery due to a sinus problem.

About 48% of patients considered their chronic headaches to be “cured”. Another 37% reported some improvement in frequency or severity of headaches. So, most patients had some improvement.

By no means a miraculous cure, considering they had a specific reason for the surgery. However, two things to remember. First, other problems were likely solved for many of these patients. And as far as surgeries go, this one is considered “minimally invasive”.

Although most specialists will consider surgery very far down the list for headache treatment, if you do have some issues with your sinuses and nasal passages, it makes sense to get it checked out at least. It could be, for a subset of patients, THE solution that should not be ignored.

18 February 2008

Simple surgery for chronic headache

James Discoveries & Stats 5

Photo courtesy of allspice1

A simple surgery is being researched that may bring significant relief to those suffering from chronic headaches. The small trial showed an increase in "quality of life" of 250% over 12 months.

The study involved 42 women and 13 men with chronic migraine. What was done? Certain superficial blood vessels on the scalp were cauterized (sealed off). That’s it. The side effects of the surgery? Temporary numbness. It sounds like it would be rather worth it.

Dr Elliot Shevel of South Africa, Professor Carlo Cianchetti of Italy and Dr Egilius Spierings of the United States are working together to do further studies on this technique.

Shevel, founder and chairman of the South African Headache Society, is also a maxillo-facial and oral surgeon. He explains how he discovered the treatment: "During the first operation I was doing on a patient’s jaw she had a pounding headache and the carotid artery on the temple was pulsing. When I blocked off the artery to the temple with my finger, the pain went away. When I took my finger off, it came back. I knew that I could cut the artery with no side effects and offered to cauterise it."

Now both South African and Italian governments have thrown in their support for future research. Though the surgery may not help everyone with chronic headache, it could be a major breakthrough for those with symptoms that are very difficult to treat.

via Surgery cures lucky headache victims