Dr. Brian Snyder, Neurosurgeon Specializing in Functional and Restorative Neurosurgery, Neurological Surgery, PC Private Practice and the Director of Functional and Restorative Neurosurgery at Winthrop-University Hospital, talks about surgery that can help treat chronic headaches.
What is neurostimulation?
Dr. Snyder: Well, neurostimulation is the use of implanted devices to apply electrical stimulation to the nervous system in attempts to modulate the circuitry and treat disease.
And so why was Megan a good candidate?
Dr. Snyder: Megan was a good candidate for occipital nerve stimulation. Occipital nerve stimulation is a technique that we are currently using to treat patients with refractory headache, migraine headache, cluster headache, and some other headache variants, when the best medical management doesn't obtain a meaningful or a reasonable outcome.
Do you mean this treatment is the last straw?
Dr. Snyder: I wouldn't call it the last straw. It's something we think about when the standard treatments aren't working. Occipital nerve stimulation, however, is very safe. It's done in a two-stage fashion where a patient has a trial in which they try the device for approximately a week prior to permanent implantation. It's something we think about after the standard medications and standard other interventions don't work.
What is it like seeing someone like Megan who's had two headaches a day, and now it's maybe once every two weeks? I mean, it must be nice to see patients with a success story like that.
Dr. Snyder: Yeah, it's amazing. It's wonderful to see people turn their lives around with something that is a relatively well-tolerated intervention. Patients with headaches with chronic daily headaches are suffering and many of the patients that we operate on are similar to Megan in the sense that they're otherwise healthy. They could be making significant contributions to society and enjoying their lives. And instead, because of their daily headaches they're incapacitated and they're unable to participate in their own lives. This technology turns many of their lives around.
There's no clear cause for migraines?
Dr. Snyder: Well, there are some causes of migraines. There are both triggers of migraines and other causes of migraines. But this technology is independent of the specific causes for specific patients. So patients with migraines that may have different triggers or may have somewhat different symptoms or presentations may still respond similarly to occipital nerve stimulation.
What is the risk of Megan's surgery?
Dr. Snyder: The risks of Megan's surgery are actually relatively small and benign, especially compared to the risks of daily headaches. Electrodes are placed under the skin but over the skull. The pacemaker is typically placed in the chest wall, again under the skin, but over the muscle, ribs, etc. So the main risks of this procedure are a small risk of bleeding or infection. These are common to any surgery or to any implant procedure. And then over the lifetime of the device there are small risks of the wires migrating, breaking, and then of course the pacemaker has a limited life expectancy. And when the pacemaker no longer works we'll have to replace her pacemaker.
She said her surgery was February of 2012, so why would people need to know about this now? What's new about it?
Dr. Snyder: Well I think in the history of medicine and the history of treatment of headaches, this is very new technology. This is very safe technology. The number of centers practicing this procedure is still relatively small, and why is that? Well it does take some amount of experience to select the right patients, to identify the patients when they have failed appropriate treatment, and then to do the surgery and place the electrodes properly and minimize any potential risks to the patient as well. [The procedure] is something we want to consider for any patients who are suffering from headaches more than 15 of 30 days a month, for example. One needs to have experience in recognizing which patients just need a change of their medication or further
therapy, and which patients are appropriate to think about for surgery however.
Are there patients whose headaches got worse after surgery?
Dr. Snyder: We certainly have seen patients who don't significantly respond to the treatment. I have not seen anyone whose headaches have worsened due to therapy. And in fact a large number of patients respond extremely robustly to the treatment. And in some instances, including Megan's, within 24 hours of the trial it was apparent that this was going to be a life-altering therapy for her.
You mentioned there is literature recently that showed good results?
Dr. Snyder: I think the literature in general is echoing what earlier studies have shown: that this technology is extremely effective at treating headaches. And what we're also seeing as the studies get longer is that the results are durable. So not only do patients respond exquisitely well initially to therapy but in many of these instances, as long as we follow the patients out after surgery, the positive response is maintained. Megan said she wouldn't drive when she had the migraines, and that's something people do every day they don't even think about.
Is this common with people who suffer from these headaches?
Dr. Snyder: Well I think there may be a tendency amongst the public to hear some of these stories and underestimate what a daily headache can mean to an individual. So some of us may have a headache once a month, or once every couple of months, and maybe it lasts an hour or two and you take some medication or take it easy and you feel better. But there are many, many people that are suffering from daily headaches, and their lives are completely turned upside down by them. They may not leave home; they may not be able to drive, or to go to school. And for many of these people that can be a near-daily experience. So to give someone the opportunity to drive or to participate in their lives in a way that they haven't been able to since they developed these headaches is really remarkable.
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If you would like more information, please contact:
Dr. Brian Snyder
Functional and Restorative Neurosurgeon
Neurological Surgery PC
Director of Functional and Restorative Neurosurgery