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'My surgery left me migraine free'

12 July 08 23:17 GMT

By Jane Elliott
Health reporter, BBC News

For 15 years Denise Richardson suffered from debilitating migraines.

Her headaches could be triggered by tiredness and stress and, at their peak, she was having one attack every two days.

Then last year she suffered a three-week headache, which was so intense she had to make several trips to her doctor.

"Due to the severity and duration of the headache I had no choice but to keep going back to my doctor who prescribed several doses of intravenous painkillers, physiotherapy on my neck, osteopathy and manipulation.

Years of pain

"I couldn't even bear to put my head on the pillow because any kind of pressure kept me awake at night.

"It was impossible for me to cope with my job during this time so my doctor put me on sick leave.

"Eventually the pain started to ease, but I felt desperate and very depressed with no prospect of either a temporary or, better still, permanent cure," she said.

While in the waiting room she read a magazine article about a controversial surgical technique that offered a cure for some migraine sufferers - a Botox injection followed by surgery.

First, a muscle in the forehead - the corrugator muscle - is paralysed with Botox and then if this proves successful the muscle is removed.

Controversial technique

However, many experts remain sceptical about the treatment with one leading UK neurologist saying he would not advise patients to opt for it.

But Denise, who lives in Germany where the treatment was being offered by Berlin plastic surgeon Professor Thomas Muehlberger, decided it was for her.

"I really wanted to believe that the procedure could cure my headaches, but was also a little sceptical having suffered so long. I was also afraid to be too hopeful in case I was disappointed," she said.

A week later the 53-year-old had the Botox injection and then kept a pain diary for two months.

"During this time the headaches decreased to about three in eight weeks with a low pain rating - obviously a good indication that subsequent surgery would be successful. I allowed myself to become more optimistic," she said.

Denise was told she was eligible for surgery and in December she had the muscle removed.

She has not had a migraine since.

"My quality of life has improved beyond anything I could possibly have imagined," she said.

"Within myself I have slowly started noticing positive differences to my life. My work performance has improved because I can now concentrate better and, most importantly, my free time is far more enjoyable and I feel rejuvenated. I have the old happy, energetic 'me' back.

"I went into the operation hopeful that, at the least, the headaches would be a lot less frequent, anything more than that I considered to be a bonus. But having no headaches at all is just fantastic, " she said.

Under the knife

About six million people in the UK suffer from debilitating migraine and Professor Muehlberger says about half of these people, like Denise, could be eligible for, and benefit from, treatment.

Last month he opened the Migraine Surgery Centre in London. Here the initial consultation is free, then the Botox test costs £320 and the surgery costs £2,780.

The technique, which was clinically reviewed in a small trial in the US, has not been available before in the UK.

But Professor Muehlberger said he had good results with the patients he had operated on in Germany.

But he is quick to stress that 50% of those wanting the treatment are not eligible.

"This is not a cure for all. The surgery is the smallest bit of the treatment, the selection process is what it is all about. It is about identifying the patients.

"I am not a magician or a guru. I am just a surgeon.

"Although the migraine procedure will not be suitable for all patients, it will offer many of those affected a real chance of freeing themselves from their migraines completely or at least reducing the severity and frequency of their attacks," he said.

And Professor Muehlberger said the London clinic was already proving very popular with patients.

"It is exploding. We really had not expected such a response like that."

But others have concerns.

Dr Andy Dowson, chairman of the Migraine Action medical advisory board, said that he would want to see extensive clinical trials.

"There needs to be proper clinical trials to say whether it works. There may be a role, but we need to see how it might work.

"I don't want to pour water over it because it might end up being useful, but there has to be a proper trial."

And Dr Paul Davies, a consultant neurologist based at Oxford's Radcliffe Infirmary, said he remained sceptical.

"The placebo response in migraine is high and I suspect [this] accounts for the results. I would not encourage my patients to go down this route."

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