37-year-old Nicole Foley of Milford suffered from migraines for most of her adult life. Like the nearly 30 million other Americans who get migraines, Foldy says her condition led to isolation because almost any stimulus could trigger her pain. "Life was constant pain. Lots of medications, I was taking up to 28 pills a day. No sounds, no smells, no light, nauseous all the time, in the ER three or four times a week. So couldn't really be a mother to my daughter, couldn't really hold down a full time job. Very frustrating."
Throughout her 20s, Foley visited neurologists in Maine and Massachusetts, but says she felt like a guinea pig and was worried about becoming addicted to painkillers. Just over 6 years ago, an Internet search brought up information about a plastic surgeon in Ohio, Dr. Bahman Guyuron, who was pioneering a new migraine treatment with Botox injections and surgery. Foley immediately began making calls to plastic surgeons in Maine and had luck with Dr. David Branch. "
And he had just gotten back from seeing Dr. Guyuron and studying with him and learning the techniques. So we set up an appointment and we did some rounds of Botox and that seemed to work."
Dr. David Branch says the Botox is actually used as a test. If Botox is injected into a migraine patient, and their pain is decreased, or if the pain moves to another part of the patient's head, Branch says that's a good sign. " That tells us that something we've done on the exterior of the brain just underneath the skin, something that we have done has altered their pain complex. And really what Botox does is it weakens muscle." I
f the Botox test works, then comes the surgery. The theory behind the prodecure, which is performed by about 150 doctors nationwide, is that many migraines occur when muscles squeeze or otherwise irritate nerves, and that disabling those muscles may stop the pain. Surgery is performed near the brow, temples and back of the head, common centers of migraine pain.
Dr. Branch removes muscle and places fatty tissue around the nerves to pad them. "We use the same criteria for success that the neurologists use for their preventative medications. And if it decreases their frequency, duration or severity of headache by 50 percent or more it's felt to be a success. And we're getting a greater than 50 percent reduction in 80 to 90 percent of patients."
Mitchell Ross, a neurologist in Auburn, is among those who question the surgical approach used by Branch. "I won't say I'm skeptical about the surgery but I don't think I would be referring anybody to Bangor for it." Ross says his office is able to help most migraine sufferers by suggesting dietary changes, or prescribing medication, massage or other traditional treatments. Ross says he's heard that botox has been used with some success. "One thing that I find interesting is that they're able to use Botox at all. I mean, the cost of the medicine is fairly prohibitive. "
At the National Migraine Association, Executive Director Michael John Coleman says his office has not taken a position on the surgery Branch performs. "His surgery is considered controversial. I do know I've talked to some surgeons in England, they thought it was bizarre. But over the past couple years I think that some of hte patients have had a positive outcome and improved quality of life so I think that has improved and given a second look to his procedure." Coleman says migraines are a genetic neurological disease that remains without a cure, and any new treatment is of interest to the suffering community.
Patient Nicole Foley says she spent about $17,000 on her Botox treatment and subsequent surgery. Even though her insurance did not contribute, Foley says the cost was worth it. "I've not had any headaches or migraines. Life happened, really. I got my life back. My daughter has her mom. So, it's been absolutely amazing. Full time job, gone back to school."
To date, Branch has performed more than 100 migraine surgeries on about 50 patients and says several insurance companies are covering at least part of the procedure. And while Branch acknowledges that many neurologists question the ability of a plastic surgeon to treat migraines, he points out that Dr. Guyuron is gaining recognition and has just published his surgical trial in the Journal of Plastics and Reconstructive Surgery.