The value and efficacy of surgery to treat migraines and other chronic headache conditions has been shown in multiple studies from various institutions across the country. However, there are multiple questions yet to be answered on the mechanism of surgery, its efficacy in relation to the specific headache types or diagnosis, and how to improve on the 75-90% reported success rate. There are multiple studies that proved the efficacy of surgery, including retrospective and prospective studies, but there has been little objective evidence that surgery changes the different mechanism implicated in migraine headaches. There has been renewed interest in neuroimaging, mostly MRI studies, in diagnosing and guiding migraine treatment. Some of the MRI changes seen in chronic migraine patients are also seen in other chronic pain conditions and have been shown to be reversible if the pain source is eliminated. This study is aimed at 1- showing that nerve decompression surgery for migraines is effective and not a placebo, and 2- shedding light on the mechanism of action of nerve decompression surgery, and whether it decreases peripheral stimuli to the brain in patients with a hypersensitive central nervous system, or eliminates a true and localized compression of one of the peripheral nerves. We are aiming to study the MRI findings before and after migraine surgery. Our team includes a plastic surgeon with a busy migraine practice, and a neuroradiologist with previous experience in studying MRI changes after treatment of chronic conditions. We will be obtaining both static and functional MRIs before and 6 months after surgery. The static MRI is to show the architectural brain anatomy, which we know is altered in patients with chronic migraines. Documenting a reversal of these alterations after a successful surgery will provide, for the first time, objective evidence of the success of surgery. Functional MRI studies the response of the brain to different triggers, emotions, stimuli, etc. The changes in functional MRIs have also been well described in chronic migraine patients. We will obtain functional MRIs before and 6 months after surgery, and compare these dynamic changes in the brain in response to stimuli that would usually trigger a migraine in each patient. This will prove that surgery changes the response of the patient to triggering stimuli, and that the result of surgery is not a placebo.
Impact:
The findings from this study will impact the 37 million Americans currently living with migraines, the society which is currently losing more than 17 billion dollars annually because of lost productivity, and the treating physicians who regularly encounter refractory migraine patients. This will help with the current controversy amongst physicians regarding the efficacy of migraine surgery. More importantly, it will provide additional evidence to the insurance companies who still would often decline to cover the surgery.