There are people trying to kill migraine with surgery. Neurologists are putting their hands on their heads
Migraine is a relatively common neurological disorder among our population that can have dire consequences for those who suffer from it. as it can become disabling for several days in a row. This means that patients’ search for treatments has become desperate to avoid having to being locked in a dark room for several days without being able to go to worksince there is no cure. The problem is that the treatments that are proposed are sometimes not the best. Among these measures we have, for example, the famous piercing in the ear that promises control headaches or even botox therapy. But the reality is that now an operation is emerging that continues to raise doubts. What does it consist of? When suffering from disabling pain, the main thing for many patients is to eradicate it, and the reality is that they do not care how to do it. That is why trigger point decompression surgery, popularly known as “migraine surgery,” is beginning to become popular in the United States. And while in the United States it is gaining more and more ground, the Spanish Society of Neurology has raised the alarm due to its proliferation in private clinics by offering great results against this disease. His story. The story of this surgery does not begin in a neuroscience laboratory, as happens with other techniques that are put into clinical practice. To understand this technique we have to go back to the beginning of this century with the surgeon Bahman Guyuron who noticed something strange: many patients on whom he performed the lifting from the front, that is, the frontal stretch, they reported that after the operation their migraines had disappeared. From there, the theory of extracranial trigger points was developed. The hypothesis is that migraine is not just a brain event, but can be triggered by compression of peripheral nerves in the face and neck due to muscles or blood vessels. Surgery in this case basically consists of releasing these nerves through decompression or cauterization. of four specific areas of the skull: In the forehead region. At the temples. On the back of the head. In the nose area. The discussion. It is not logically conflict-free. On the one hand, there are American surgeons who They assure that between 70% and 95% of patients improve or eliminate their symptoms. However, when we turn to rigorous scientific literature, the numbers become considerably nuanced. The magazine Frontiers in Neurology, who analyzed the data of 627 patientsrevealed a very clear reality. Only 38% of patients undergoing this operation recorded a remission of headaches after 6-12 months. And this is a very controversial figure, since private clinics promise figures that are not what independent studies point out. The study explicitly warns that more elaborate and transparent tests are neededsince the risk of bias in patient selection is high. That is, those patients who are giving the best results are chosen, giving a success value that is not totally real as it does not follow the quality standards expected in a study. In Spain. Our country has gone up in arms against these types of surgeries that seem like a miracle, and the Spanish Society of Neurology (SEN) He does not see the physiological basis behind it that explains its effect. The first thing they see is that the studies are too small (which leaves the results obvious), but they also point out that migraine is a disease of the central nervous system and that “decompressing the nerves” outside the skull lacks biological plausibility. Specifically, the conclusion reached in the SEN is the following: There is no scientific evidence that currently supports that surgery has a therapeutic role for migraine. Therefore, any migraine patient is not recommended to undergo surgery for this disease. Migraine has been studied in depth, and there is no solid evidence that these nerves are compressed in migraineurs. And they go further by pointing out that “migraine has no cure, but there are many scientifically based therapeutic developments and more are to come.” Placebo effect. To understand it, we must know that surgery is an intervention that is imposed on anyone, and the simple fact of going through an operating room generates in a patient the feeling or expectation that they will be cured. That is why this is about measuring in the control groups, which are those patients who enter the operating room, but who do not receive nerve decompression (although they think they do). In these cases it has been seen that patients point out that their migraines have improved, when this is not the case. All motivated also because measuring the intensity of pain in a patient is not easy at all, as it is tremendously subjective, since each person perceives it in a specific way. Your application. In Spain, the technique moves in limbo. It is not financed by social security nor endorsed by the Network of Health Technology Assessment Agencies (RedETS), but it is offered on the private market with prices ranging between $5,000 and $15,000. But the recommendation of specialists in this case is that “any patient with migraine is not recommended to undergo surgery for this disease.” The only exception they make is that you are going to participate in a clinical trial. Images | Adrian Swancar Akram Huseyn In Xataka | Splitting an ibuprofen in half to take 600 mg instead of 400 is a bad idea: it destroys a key piece of its engineering
