August 7, 2019

Nerve-releasing surgery eases migraines for some

Peripheral nerve surgery is relieving chronic migraine headaches for some patients.


Hope Dyer has seen a significant reduction in the number of migraines she has after plastic surgeon Salam Kassis, MD, performed an outpatient surgery to release entrapped nerves in her head.
Hope Dyer has seen a significant reduction in the number of migraines she has after plastic surgeon Salam Kassis, MD, performed an outpatient surgery to release entrapped nerves in her head. (photo by Anne Rayner)

by Jill Clendening

Clarksville resident Hope Dyer remembers the day she looked out a window, saw it was raining and immediately began crying. She realized it was the first time in more than two decades that a drop in barometric pressure before a storm hadn’t triggered a debilitating migraine.

In November 2018 Dyer underwent peripheral nerve surgery at the Nashville Veterans Affairs Hospital with the goal of relieving her chronic migraine headaches. The outpatient surgery is now also being offered by the same team of plastic surgeons at Vanderbilt University Medical Center.

“I started getting migraine headaches when I was 14, and it had gotten to the point I was getting them from 18 to 25 days every month,” said Dyer. “Now, I have maybe just five a month. I’m getting out, and I’m doing things now. I’ve been to concerts, and I didn’t wind up in the emergency room because of the flashing lights. My family and friends aren’t getting calls saying I won’t be there because of a migraine. This has been life changing.”

Migraine headaches, estimated by the National Headache Foundation (NHF) to affect more than 37 million in the United States, can last hours to days and are often accompanied by nausea, vomiting and extreme sensitivity to light and sound. The pain and other symptoms dramatically impact quality of life for those who experience chronic migraine headaches.

Migraine headaches have long been defined as originating in the brain, but two decades of research data points to another source for some sufferers — the compression and entrapment of the peripheral and extracranial sensory nerves of the head and neck.

The connection between nerve entrapment and migraine headaches was discovered by chance by Bahman Guyuron, MD, former chair of the Department of Plastic and Reconstructive Surgery at University Hospitals Case Medical Center.

“Plastic surgeons perform cosmetic procedures like brow lifts and resection of the frown muscles, and patients who had these types of surgeries had been coming in for follow-up appointments saying, ‘I feel so great, even my migraines went away,’ ” said Salam Kassis, MD, a Vanderbilt Health plastic surgeon who performs the procedures.

“Now, there’s two decades of peer-reviewed research that shows that surgically releasing nerves entrapped and compressed by muscle, fascia, bone or even by a blood vessel can give significant relief for this select group of migraine headache patients. We call it the carpal tunnel surgery of the head because it’s the same concept.”

According to clinical research, half the people who undergo surgery to release the nerves will experience complete relief from migraines and 40% will show improvement in the intensity and frequency of their headaches. For 10% of these patients the surgery will not help, Kassis said.

In April 2018, the American Society of Plastic Surgeons issued a policy statement supporting the procedure stating, “peripheral nerve trigger surgery for treatment of refractory chronic migraine headache in properly selected patients is not an experimental treatment and is considered a standard, accepted treatment given nearly 20 years of peer-reviewed published evidence in high impact factor journals.”

Ideal candidates for the surgery have migraine headaches that significantly affect their quality of life, and their migraines are poorly controlled by medications. In addition, individuals who are the best candidates can identify one or more trigger points on the face or neck where their pain begins, Kassis said.

Surgery to release entrapped nerves is performed on either the face or the neck or both, depending on where the pain originates. The one- to two-hour surgery is outpatient, and patients typically experience some minor soreness and bruising.

Adam Pressley’s earliest migraine memory was at around 9 years old. He just turned 31, and during his six years in the Army, he would warn new commanding officers that he suffered severe migraine headaches as often as five to seven days a week.

“My military service aggravated my migraines, and essentially every day I would just push through the pain,” he said.

“I remember one day on deployment when I barely made it through to the five o’clock briefing. Then, my body seemed to say, ‘You’ve made it through the day, let go.’ I almost vomited on my command sergeant major’s shoes.”

In November 2018 Pressley had the surgery with the VUMC team at the VA hospital. He gets choked up when he talks about the difference it’s made.

As a husband and father of a 6-year-old son and 9-year-old twin daughters, he now enjoys time with family rather than being isolated in a darkened bedroom.

The family even enjoyed a 10-day vacation to Walt Disney World without a single interruption by a migraine. Pressley’s also gone back to school and works two part-time jobs while he completes his degree.

“The day-to-day migraines I was getting — the ones that kept me from enjoying life — are out of my life,” he said.

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To schedule a consultation with VUMC plastic surgeons to be evaluated for the migraine headache surgery, call 615-936-2700.