Can migraines be cured without medication? According to the latest research, it’s where treatment is going.

It’s a pain that torments so many people – the migraine. It debilitates sufferers, and ruins their lives. But there’s hope. A relatively new treatment regime formulated by Dr Elliot Shevel, a South African surgeon who specialises in the face and jaw, is receiving growing international recognition as the most effective way to relieve chronic migraine pain.

Brimming with passion for what he calls his “life's work”, he explains: “We're on the verge of a whole new era of understanding what causes the migraine, thanks to a study by a Dutch neurologist. He proves what I've been saying for the past two decades: the pain of migraine doesn't come from inside the brain, but rather from structures outside the brain – like muscles, superficial scalp arteries and nerve systems.”

This study, published in the British neurological journal Brain, was led by Dr GG Schoonman of the University of Leiden in the Netherlands. He used a hi-tech scanner, called a 3T magnetic resonance angiogram, to measure arteries in the brain. His conclusion? Contrary to long-standing belief there is no widening of the arteries, known as vasodilation, inside the brain during a migraine. Just what Dr Shevel has been saying all these years...

This conclusion has rocked migraine research to its core. Because for the past few decades migraine patients have been treated with drugs such as ergots and triptans, which are drugs specifically designed to constrict blood vessels and thereby reverse the assumed abnormal dilation of arteries inside the brain.

“No wonder the drugs have such poor results,” says Dr Shevel. “For over half a century and without any proof the medical and scientific communities have clung blindly to the erroneous belief that there is widening of the arteries in the brain during migraine. Millions of sufferers could benefit if outdated science is finally discarded.

“Schoonman's study, which proves I'm on track, has sent shock waves through the old guard of headache specialists. Many find it difficult to abandon their established ways, either because they're funded by the pharmaceutical giants or they can't handle their life's work being proved wrong.”

Tying off certain arteries
According to Headache Australia (Headacheaustralia.org), migraines are headaches that last anything from 4 hours to 72 hours at a time. Many sufferers experience nausea and vomiting, as well as sensitivity to light.

There are an estimated 2 million migraine sufferers in Australia.

Holding a plastic skull marked with red lines that depict the various cranial arteries, Dr Shevel talks of his growing understanding of migraine pain. He has been treating migraines for almost 20 years and is the only surgeon in the world to relieve migraine pain by tying off certain arteries outside the brain.

By shifting his gaze to the structures outside the brain he's found that the headaches are caused primarily by arterial pain, muscle tension or – in most cases – a combination of both. As a result he and his team at The Headache Clinic in South Africa have devised novel migraine treatment options that don't rely on drugs.

These include the handy Posture Modifying Appliance, designed by Dr Shevel and patented in South Africa and the USA in the early 1990s.

Basically it's a custom-made palate that corrects the positioning of the jaw to ease muscle strain in the face, neck and head, and particularly to relieve tension on the jaw and neck muscles.

But Dr Shevel’s most groundbreaking treatment is arterial surgery, which he stumbled upon in 1995 when a patient who was scheduled for mouth surgery complained of a severe headache.

“l noticed a blood vessel pulsing on the side of her head. When I pressed it, the pain disappeared. When I lifted my finger, it returned. I had no doubt these arteries were causing the pain and it wouldn't be too risky to tie them off.”

He performed the procedure and his patient's migraines disappeared...

Success rate of 85%
Dr Shevel has used arterial surgery to treat hundreds of chronic migraine sufferers. His estimated success rate is 85%, and headache specialists around the world are showing a growing interest in this technique.

And Dr Shevel’s not finished yet. In fact, some of his other research involves cryosurgery: a probe is used to freeze rather than cut or tie off the arteries responsible for the migraines. This advancement could make the already minimally invasive procedure almost bloodless.

In July 2007 a report on his breakthrough surgery was published in the international journal Therapy. It was accompanied by a study showing that 55 patients reported an approximately two-and-a-half times improvement in their quality of life a year after the operation. The small number of patients who continued to experience migraines reported fewer, less severe migraines.

Dr Shevel and Harvard University's Professor Giel Spierings have also co-authored a report, published in the American journal Cranio, showing that extra-cranial arteries that have no connection with the brain are involved in migraine pain.

Each new study takes modern migraine wisdom another step away from outdated principles and practices – and hopefully a step closer to relief for migraine sufferers.

But the search for new answers has not been called off. Debate between migraine practitioners and between sufferers continues.

“The option to have a safe and effective procedure at a day clinic will change people’s lives,” Dr Shevel says. “This is one of the first viable, tested options to daily medication. For many patients medication is largely ineffective and even exacerbates the problem in the form of the Rebound Headache Condition – where the drugs actually bring on migraine pain. The surgery provides a safe and permanent solution for millions of sufferers.”

What to do
Do you suffer from migraines or really painful, regular headaches?

Whether you call it a migraine or a headache, find out which structures are causing the pain first. Start self-diagnosing by getting your hands onto your head. Feel every inch of your head: rub, compress, massage. Learn! Learn to self-massage or teach your partner, spouse, friend, parent or child. Massage should be firm but never painful.

If your doctor doesn't display a complete understanding of the anatomy of the muscles, nerves and arteries of your head, face and neck, and if he doesn't examine those structures with his hands, you’re wasting your time.

According to the International Headache Society, if you’re taking headache medicine more than twice a week you’re at risk of developing MOH or rebound headaches. This means the drugs cause more severe and more frequent headaches or migraines. It’s a downward spiral into constant medicine use and constant pain.

How to cope with migraines and headaches

Do:

    • Eat balanced meals three times a day with healthy snacks in between to make sure your body gets the nutrients and energy it needs.

    • Put an ice pack on your forehead to help narrow swollen arteries and relieve tension headaches.

    • Avoid bright flashing lights. A television or computer screen can also contribute to a headache.

    • Breathe deeply – this promotes relaxation, relieves tension and provides more oxygen to the blood vessels.

    • Massage your neck and shoulders or have it done by a therapist.

    • Stretch for at least five minutes a day to loosen stiff muscles. Stretch your neck and jaw muscles carefully and gently.

    • Keep a headache diary: take note of when the headache started, how long it lasted and what you consumed that could have triggered it.

    • Exercise regularly to relieve tension and stimulate circulation.



Don’t:

    • Skip meals. Keep your blood sugar levels stable by eating regularly and at least three times a day.

    • Take too many painkillers. Your body becomes accustomed to them and they can make headaches worse in the long run.

    • Lose out on sleep. Fatigue is a major cause of headaches, so aim to sleep seven or eight hours a night.

    • Sleep on your stomach or in any position that causes muscle spasms in your neck.

    • Have any foods or drinks that have been identified as triggers (e.g. coffee, chocolate or alcohol). But remember: only about 20% of sufferers have identifiable migraine triggers.



Image via Thinkstock.




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