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Dr. Guyuron says.“ Even if you take the placebo effect into consideration, the surgery has a substantial effect. Patients are symptom-free or significantly improved.”
Richard B. Lipton, MD, director of the Montefiore Headache Center in the Bronx, N. Y., and professor and vice chair of neurology at the Albert Einstein School of Medicine in New York City, says the surgery has proven its value for select patients, but additional studies involving independent headache experts would increase confidence in the results.
“ The approach is directed to the identification and treatment of factors outside of the brain that can make migraine worse, sometimes called peripheral factors,” he explains.“ While it seems radical to some, mainstream migraine treatment has long included identifying other peripheral factors— for example, disease of the cervical spine, disease in the nose( concha bullosa) and temporomandibular joint disorder( TMJ). These peripheral factors vary from person to person.”
Though Dr. Guyuron’ s treatment responses are impressive, Dr. Lipton cautions that this surgical approach is not for everyone.“ Successful treatment depends upon targeting the factor, or factors, that matter in a particular individual,” Dr. Lipton says.“ For many
patients, there is no peripheral factor, and this approach is, therefore, not relevant. It should be considered only for severe migraine sufferers who have not responded to less invasive and more conventional approaches.”
Dr. Guyuron agrees.“ These have to be serious, disabling headaches,” he says. He recommends the surgery for only a specific set of migraineurs— those with at least two or more migraine days per month who have either not responded to medications or for whom medications are not recommended or tolerated. Before he will operate, he also insists patients have a diagnosis of migraine from a neurologist and don’ t have medication overuse( rebound) headaches.
Even with the latest study, not all headache specialists are convinced.“ This surgical procedure is still highly controversial in spite of the success rate in the reported study,” says Arthur Elkind, MD, director of the Elkind Headache Center in Mount Vernon, N. Y., and president of the NHF board of directors.“ It is difficult to have a scientifically controlled group when the treated individuals are subjected to an invasive procedure. A large double-blind study with a sham procedure is still needed, and the patients will need to be evaluated by another physician who is not aware of the treatment given.”
For more information about ongoing research or to participate in clinical trials, go to www. headaches. org / Clinical _ Trials.
The Heart and the Head
Children who suffer from migraine with aura may be twice as likely to have a common congenital heart defect, according to a new study published in the Journal of Pediatrics. Nearly 50 % of children who had migraine with aura also had a defect called patent foramen ovale( PFO)— essentially a small hole in the heart. This is nearly double the rate in the general population. Only 27 % of children who had migraine without aura had the heart defect.
“ These data suggest that PFO may contribute to the [ cause ] of migraine with aura in children and have implications for clinical decision making,” said lead author Rachel T. McCandless, MD, in the study’ s conclusion.
Researchers examined 109 children ages 6 to 18 who were diagnosed with migraine by pediatric neurologists at the Primary Children’ s Medical Center in Salt Lake City between February 2008 and September 2009.
The relationship between migraine and PFO is not fully understood, but if PFO does contribute to migraines, health care professionals might be able to treat affected children with a simple catheter device.
50 Percentage of childen with migraine with aura who also have PFO
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