Dr. Ivica Ducic: Microsurgery as a Cure for Migraines - [Video Transcription]
- What causes migraine headaches?
Processes are quite complex. I think science is still getting a grip on what exactly the reasons and causes are. There are certainly hormonal changes and vascular changes. Lately, we are learning also that nerves involved in the periphery in the back, front, or side of the head can certainly contribute or be the main cause of the chronic headaches and migraines.
- How do I know if this micro-surgery will work for my headaches?
The patients can have a headache in the back of the head, front of head, or side of the head. Unfortunately, it is a combination of the above more often than not. Despite the optimal medical care provided, they have a tenderness over these nerves. This means that if you press on these nerves, they hurt. That is usually a characteristic of a nerve that is troubled as we know from anywhere in the body that is the case. Then, they can have injection of a numbing medication or with Botox in the area. If they respond positively although temporarily to that injection or block that indirectly tells us that the generator for their headache and pain is the peripheral nerve in that anatomical region. That is when they become suitable candidates for surgery.
- How does the headache surgery that you do, work?
Surgery works in that we decompress the nerve either in the back of the head, front of the head, or side of the head. It is similar to the carpal tunnel in the wrist, cubital tunnel at the elbow, or any other compressed nerve in the body. We take the pressure off the nerve. It is equivocal to taking your shirt and tie off when it is too tight for your neck making you not able to breathe or speak normally although your lungs and mouth are completely normal. Once you decompress them by removing small portions of the muscle that is compressing the nerve against the vessels and the bones, then the patients get symptomatic relief and the headache goes away in most of the patients.
- What is the standard surgical method and why might your technique be better for me?
The "gold standard" for these types of headaches used to be practiced in a number of centers across the country and still practiced would be a neurosurgical approach where you would expose the nerves where they come out from the spine and clip them there. First, it is a much more extensive surgery and doesn't give a chance to preserve sensation. Our approach with the compression of the nerves gives about 75 to 80% of the patients who respond positively to preserve sensation and not need such an extensive surgery. Alternatively, people have practiced placement of nerve stimulators. That is about a $30,000 battery implanted in you with a couple feet of wires that get placed next to your nerves. It can confuse the system and destruct the pain so that you don't feel the pain. The reason that I don't do that is obviously the cost of the hardware. Secondly, we are still not treating the cause of the problem but just fooling with the symptoms. I would say that either of these two alternatives are inferior to the one that we practice.
- How do I know if I am a candidate?
If the medical care doesn't provide you pain relief and if you have tenderness over the nerves and are responding favorably to a nerve block or Botox injection, then you are a candidate for surgery. In reality, every patient with a headache that have other sources of headaches excluded i.e. tumor, metabolic, hormonal, etc whose medical care doesn't provide them adequate or consistent relief should seek information if not evaluation for the possible surgical treatment. If not, we can provide the blocks and Botox then ultimately surgery.
