What Really Causes Migraine Headaches?

Speaker 1 (00:01):
You are listening to HEAD ON with your host, board certified plastic surgeon, Dr. Bahman Guyuron, the pioneer of a life-changing surgery for permanently eliminating migraines and a specialist in plastic surgery of the face, head and neck.

Dr. Guyuron (00:20):
First of all, headaches are extremely common and migraine headaches are very common as well. In fact, 20% of the females and 6% of the males, and almost in average 15%, 13 to 15% of the entire population have migraine headaches. Migraine headaches are in general genetic in disposition, meaning the patients who have migraine headaches, we have demonstrated through scientific studies that they're missing a membrane around the nerve that is called myelin. Myelin behaves like an insulation around the nerve and protects the nerve, and if there is in any way damage to that, myelin is going to make the nerve more vulnerable and elements that ordinarily do not irritate the nerve like pulsation right next to the nerve in a contraction of the muscle, or even the small bands that are putting some pressure on the nerve are going to cause migraine headaches. In fact, the nerves are always with muscles and vessels, but they do not get irritated.

(01:45)
So that is the difference between a patient who has migraine headaches and the one who doesn't, and not always there's a family history, but in overwhelming majority of patients who have migraine headaches, there is actually a family history of migraine headaches, but also sometimes that damage to the myelin can be caused by other things such as injury, specifically whiplash injury, whiplash injury. What it does stretches the nerve and damages that myelin that is again around the nerve and produces similar condition to migraine headaches. But obviously there are some differences in terms of the symptoms, but in terms of the surgical treatment, it doesn't really make that much difference. We treat them almost exactly the same way. There are some clear and standard definitions to migraine headaches and sometimes the headaches do not really fall in that definition, but in general, they're supposed to last somewhere between four to 72 hours.

(03:08)
They're supposed to be serious causing some nausea, vomiting, fear of lights, fear of sound, and often they're disabling, but generally tension headaches would not do that. They're not associated with nausea or vomiting. They usually are somewhat less intense, but there are a whole host of headaches that are variation of migraine headaches and fortunately all of those fall in the category that can be treated surgically. The best way to make a diagnose some migraine headaches is to talk to a neurologist because there are conditions that emulate migraine headaches. They may not be, fortunately, they're rare, but unfortunately when they occur they're very serious. So I have never operated on a patient who did not have diagnosis of migraine headaches by a neurologist, and it is actually a requirement for me to at least somebody who has expertise in the headache area to make the diagnosis of migraine headaches before I do the surgery.

(04:35)
Migraine headaches have different variations. Some are episodic, meaning they come and go, and they usually are fewer than 15 headaches a month. Some are chronic, meaning they're more than 15 a month, and some patients have actually have migraine headaches every day and everybody's headache may behave differently. But again, fortunately, most of these subcategories of migraine headaches respond to the surgery. Those are the two main divisions, chronic and episodic for most patients. Migraine headaches are triggered by a variety of elements factors including some food products. Some patients have weather change, hormonal changes can cause migraine headaches. That's why some patients have more serious headaches during the menstrual periods, and some patients actually can predict a weather change and some patients cannot drink coffee. On the other hand, some patients actually treat their headaches with coffee, so it is a very, very individual matter and there are actually a lot more triggers.

(06:03)
But from the surgical point of view, many of those triggering elements are increasing the irritation of the nerves either through increase in the blood pressure that's going to intensify the blood flow in the vessels or because of enlargement of the structures inside the nose that we call them turbinates. That's why patients sometimes wake up in the middle of night or in the morning with headaches because when they lie down, those structures inside the nose become larger, more engorged, and there's more contact between the different structures that trigger headaches. And fortunately we can use those constellation of symptoms to decide where the headaches are starting from, what is causing them and go after those triggering elements. Often the patients know what triggers their migraine headaches and they try to prevent it by avoiding those factors such as drinking alcoholic beverages. That's probably is one of the most common ones, but chocolate can actually trigger headaches with some patients and spicy food, again, the weather change, flying because under those conditions, the structures that we call them turbinates become larger and contact points increase or become intensified.

(07:47)
And similarly, some food or some specific foods can cause headache and the patients actually learn to reduce it or rarely prevent it. There's really no regimen that can hundred percent prevent the migraine headaches, but can mitigate the symptoms or can reduce the frequency of headaches. So many patients can figure out being tired, being in a sunny environment can trigger headaches for some people, fluorescence can trigger for headaches for some patients and the patients, again, learn how to avoid those. Most patients that have migraine headaches, try different treatment themselves, such as taking aspirin, Advil, Aleve, and application of cold compressors or eyes or pressure and pressure particularly is a very important piece of information for us because what they are doing is essentially by pushing in certain areas themselves or asking the spouses to do that is an indication of what they're doing is compressing the blood vessels, stopping the blood flow in the vessel that is irritating the nerve.

(09:12)
And if they can point to where they're pressing, actually help us to go to the trigger site, they lead us to the trigger site. All of the trigger sites essentially are between the skin and the bone, except for the trigger sites inside the nose that they're very deep because they usually are coming from the septum and turbinates touching each other. And otherwise we operate on the surface most of the time to take care of the patients with headaches. Patients who have headaches arising from inside the nose commonly can predict a weather change, usually cannot fly without headaches or the headaches are very serious during the menstrual periods because the hormones alter the volume of the structures inside the nose and create more contact points. Some patients have migraine headaches, benefit from acupuncture, some benefit from radio frequency, ablation, nerve blocks, injection of steroids around the nerve, and even the external devices that send waves to the nerves to again reduce the frequency or severity of migraine headaches.

(10:52)
Another nonsurgical procedure which helps the patients for approximately two months is Botox. First of all, it doesn't work on everybody, but often the results are temporary as long as the patient is getting the Botox and sometimes before the insurance duration insurance approved duration elapses, the symptoms may recur because most of the time the insurances cover for the injections every three months, but unfortunately most of the time the Botox effect lasts only two months. So as soon as the Botox effect goes away, the symptoms are going to recur. And for some patients, actually Botox doesn't work or works initially and after a while it becomes ineffective. And there are certain sites, certain trigger sites and types of migraine neurology that Botox doesn't work at all. Unfortunately, all of the modalities that mitigate reduce the migraine headaches such as medications such as acupuncture, such as nerve blocks, or any type of ablation, ablative procedures, produce temporal results, and that's why surgery becomes very, very important in terms of longevity of the results. We have demonstrated the results of surgery last essentially permanently. Nothing is permanent. We follow up a lot of patients for the entirety of their lives. We're going to be able to be sure about it. But results of migraine surgery last very long time and we have demonstrated that scientifically.

Speaker 1 (12:59):
Links to learn more about Dr. Guyuron and anything else mentioned on this podcast are available in the show notes. HEAD ON is a production of The Axis, THE AXIS.io.