Migraine Surgery

Q: Dr. Eppley, I m interested in migraine surgery. I will try to be brief about my migraine history. Twelve years ago I was in an auto accident. I had/have hereditary stenosis of the C-spine. Things in my neck shifted enough that I needed a vertebra removed. I had a vertebra and disk ripped apart in my lumbar spine. I have mild tingling and numbness in my hands. I have chronic pain in my neck and lumbar that like my head never goes completely away. From the beginning I received epidurals in my lumbar and neck, although the full pain was never covered up. In 2011 I had a new pain management Dr. who had just done a  nerve block in my neck and asked how I felt. I said much better, now if you could get my head to quit hurting… He took my head PAIN seriously. Everyone before thought I just had a headache. He did nerve blocks on the outside of my skull, at the nerves. I almost cried. For 7 years I had… you know what it feels like to smash your thumb? That’s how my entire head felt for 7 years, my knees almost buckled from relief. He learned, on my behalf, how to do Occipital RFA’s.

I’m tired of fighting insurance and government procedures. I hope to have 20 or 30 years left, and I want something more permanent. It not only affects me but everyone around me. My wife deserves better and the best I can be. With blocks and RFA’s the chronic pain becomes less. I would love to be able to get off of the pain meds I’m on. At least reduce the levels. I am tired of being treated like a criminal because some people abuse their drugs and others who suffer from extreme pain are called druggies for over dosing when it’s cleaner than other ways and doesn’t involve others. I don’t like being in pain.

Please consider me for migraine surgery.

A: Thank you for detailing your history. The critical question, as in all chronic migraine patients including occipital neuralgia, is whether occipital nerve decompression would be effective. While you have some suggestion that it may have some benefit (positive response to nerve blocks and RFA), there really is no way to know with any certainty unless some simply does the procedure. The main qualifier for me as to whether one should undergo external occipital nerve decompression surgery is two-fold; 1) the patient accepts the uncertainty of the outcome and 2) Should the procedure not be effective there is nothing else surgically I can do to try and make it work better. In other words I do the maximum extent of the surgery knowing that this is a one time short for relief.

Dr. Barry Eppley

Indianapolis, Indiana