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For 20 years, Nicole Foley, from Carmel, regularly endured intense bouts of pain from an ailment that doctors could diagnose but not cure.
Like millions of people, Foley suffered from migraines, a genetically-based debilitating disease with many symptoms, including hypersensitivity to light and noise, nausea, and numbness that lasted for hours, even days. Sometimes it was so bad that even the gentle light of candles was unbearable and the smell of dinner on the stove made Foley sick to her stomach.
“It was excruciating,” says Foley, who suffered from migraine attacks at least three times a week. For years she tried changing her diet to avoid some of the triggers that scientists have found can cause migraines—caffeine, red dye, and chocolate, to name a few. When that failed, she turned to medicine and solitude, which for a mother of a teenage daughter, is hard to come by.
Her cocktail of up to 28 pills—some to curb the pain, some to help her sleep, and others to offset side effects of the first two medications—was how she treated the worst of her migraines. “It wasn’t a way to live a life or raise a kid,” Foley says. She couldn’t work a 40-hour workweek, go out with her friends, or attend her daughter’s school functions without pre-medicating.
Frustrated that the pills were only masking the problem, not eliminating it, Foley turned to the Internet for help. Through her research she learned about an under-the-radar surgery procedure developed by Cleveland’s Dr. Bahman Guyuron, an internationally recognized pioneer in plastic surgery. And as luck would have it, Bangor plastic surgeon Dr. David Branch was one of only a few doctors on the East Coast trained in Guyuron’s methods at Case Western Reserve University in Ohio.
Branch’s procedure for determining if Foley was a surgery candidate started with Botox treatments. “Dr. Guyuron actually discovered the Botox effect by accident,” Branch says. “He found that some of his patients who had cosmetic facial enhancements with Botox stopped having migraines. When the Botox wore off in three to six months, the symptoms returned.”
Guyuron found that Botox temporarily weakened the muscles connected to the nerve branches that trigger migraine headaches. Knowing this, he developed a more permanent surgical fix to the problem, by disconnecting those muscles from the migraine-triggering nerves.
“Botox is still the first step in migraine surgery,” Branch says. “It’s how we locate and identify the trigger sites.” For example, if a migraine patient’s symptoms disappear after a Botox injection in the brow trigger site, Branch then knows that site will likely respond to surgery.
Once all the trigger sites have been determined, the surgery itself is an outpatient procedure under sedation or general anesthesia. The trigger sites are treated through small, often hidden incisions, relieving pressure on the nerves that cause headaches. The entire outpatient process takes from one-and-a-half to five hours.
The overall results of the procedure show amazing success. According to data collected by Guyuron and those he has trained in the procedure, of the 60% to 80% of migraine patients who respond favorably to the injection of Botox, 90% of those benefit from the migraine surgery. Over the past decade, four out of five patients who have undergone the surgery have a significant reduction—by half or more—in their symptoms. For one out of three patients, the migraines disappeared completely.
“This procedure is making its way into mainstream medicine,” Dr. Branch says. It’s starting to be taught in residency programs like Dartmouth-Hitchcock. Right now, as the only physician offering this in greater New England, Branch treats patients from near and far, one as young as 10 years old. They all seem to have the same reaction: extreme relief.
“I’ve done reconstructive breast surgery, and repaired severely damaged faces and hands,” Branch says, “but I’ve never known more grateful people than the migraine patients I’ve been able to help.”
Why aren’t migraine sufferers lining up for the surgery? For one thing, the procedure is still largely a secret, even by referring physicians. Another is that the majority of insurance companies do not cover the surgery or Botox injections, causing migraine sufferers to pony up the $3,500 to $16,000 on their own. (Despite the lobbying clout of pharmaceutical companies that supply migraine sufferers with billions of dollars in pain relievers each year, Branch believes migraine surgery will eventually be covered by most carriers.)
The selection process also takes some time. Patients must be seen by a neurologist and have a diagnosis of migraine disease to even be evaluated by Branch or his colleagues in other states. Testing must be done with follow-ups in six-week intervals until all the trigger zones are identified. Only then does surgery become an option.
But for Foley the pros of the surgery outweighed the cons. For the first week or so after her operation, Foley had minor headaches. But after that the pain was gone for good. “It was weird at first; it was a foreign feeling,” Foley says about living without migraine pain. The drastic positive changes in her life made the surgery worth it.
“I always tell people that Dr. Branch is my hero,” Foley says. “He gave me my life back.”
