Neuromodulation
Surgical Treatment for Migraines
Everyone has had a headache at some point in their life – whether it's from tension, lack of sleep, or something else – everyone has experienced head pain. There are more than 300 types of headache. While headaches may interfere with work or relationships, most sufferers do their best to lead normal, active lives and most people with a headache can take an over-the-counter pain reliever that helps their pain.
Recurring headaches, however, are a real problem for an estimated 60 million to 80 million Americans. More than 29 million people in the United States suffer from migraine, a type of headache that can be chronic and incapacitating, interfering with school, work, relationships, and life. Migraine affects women three times more often then men and often is misdiagnosed. Most people who experience migraine have a family history of the disorder.
For people with migraine, finding the right treatment can change their lives. For some people, avoiding triggers such as drinking wine or eating certain cheeses or even making sure they get adequate sleep helps prevent migraine. For others, preventive medications help and medications called "triptans" can help an individual manage their migraine attacks and lead normal lives.
For some people, no matter how hard you try, how many triggers you avoid, how many doctors you visit, how many medications you take, how many alternative treatments you try, migraine takes a hold of your life and won't let go.
When this happens, it's called transformed migraine and 5-7% of people with migraine develop this type of headache. People with transformed migraine have a history of migraine attacks that become more frequent and eventually become a chronic daily migraine headache with a daily or near-daily background headache that feels like a typical tension headache.
In the past, migraines were considered vascular – or blood vessel-related – headaches. They were thought to occur when shifts in blood flow suddenly expanded the blood vessels in and around the head, causing pain. Now, the most current and respected findings suggest that migraines and other primary headaches arise from disturbances within the central nervous system. These disturbances trigger a cascade of chemical changes that cause inflamed blood vessels and neurological symptoms, including pain. Because of these findings, there may be new treatments for migraine.
"Right now, there is no good treatment for transformed migraine," says Dr. Kenneth Alo, a pain specialist in Houston. He and his colleagues hypothesized that transformed migraine may respond to peripheral nerve stimulation because of the neuropathic nature of transformed migraine symptoms in some patients.
Classic migraine treatments are directed at the blood vessels but have no effect on neuropathic pain (nerve pain). Peripheral nerve stimulation is effective for many people with neuropathic pain. "Some transformed migraine is like nerve pain – it's sort of like sciatic nerve pain. That's the reason why the drugs don't work," Dr. Alo explains. "Stimulators control the nerve pain, and that's why it controls the pain of transformed migraine in some patients."
For Shari Wendt, a 32-year-old mother in Texas, life became "pure hell" because of transformed migraine – until she found some relief with a neurostimulator.
Shari says she was a normal teenager growing up who sporadically had headaches and migraine. She went to her local doctor, who prescribed medication, but it never really helped. In 1993, Shari's headaches took a turn for the worse while she was in college. "I contracted meningitis. They didn't know which type it was, and I ended up in the hospital for 10 days," Shari explains. "Ever since then – every single day of my life – I've woken up with a splitting headache. I was a teenager, and I lost my life. I couldn't do the things normal teenagers do," Shari says.
Shari visited neurologists in the Houston area and tried "tons of different types of medications over the years but none of it worked," she says. She entered a specialized headache program and followed the protocol but found no relief. "I missed out on a lot. I spent a lot of time in bed because I was on heavy narcotics and pain shots. I went from neurologist to neurologist, hoping that someone could help me. I was willing to try anything," Shari says. But nothing worked.
Finally, one doctor diagnosed Shari with three types of headaches – daily chronic headache, migraine, and pseudotumor cerebri, a condition where cerebrospinal fluid builds up around the brain. "He was the only one who could give me an answer to what was going on, but he only offered more medications and those didn't work," Shari explains.
Shari says she was determined to finish college and she did, though it wasn't easy. "All I ever wanted to do with my life was be a teacher," she says. "I think that's just what kept me going because I was in so much pain. I'm the type of person who – when I have a vision – I'm not happy with myself until I get it done. I made it through, but I missed out on a lot. I missed a lot of classes, but I graduated with honors. I had to take so much medication, but I got it done."
Shari calls that time in her life "pure hell." She lost friends and became distant from family members. "My mom stood by me – she was there with me through everything because she was the only one who could sympathize with me – she had migraines and knew what the pain was like. I don't like to relieve those years because I'm not the type of person to say 'Oh, poor me,' but it really was pure hell," she explains. "I wasn't able to go to my sister's wedding. My family life suffered."
Shari did get married in 1997 to a man who has stood by her through it all. She began her career in the Houston area, where she taught for six years. "My work kept me going, but it also suffered because I missed a lot of work," she says. "When you're a teacher, you have to be there every day for those kids."
In 2002, everything came to a boiling point. Shari says she was missing a lot of work and her family was worried about the amount of pain medication she was taking every day. "My husband and my mother stepped in and told me I had to quit," Shari explains. "I gave up my job and focused on getting off the pain medicine, which helped a lot because I was having rebound headaches from all the medications."
Shari says she still didn't have much of a life, but was feeling slightly better. "I felt like I was 30 years old and life was passing me by. I really wanted to have children, so we decided to get pregnant. Like I said, I have a one-track mind and I was determined. I'm going to have a child, I'm going to take care of it, and it was going to take my mind off of my pain," she says.
During her pregnancy, Shari's headaches were rare so everyone thought the headaches were related to her hormones. Unfortunately, hormones were not the answer. "After I had my child, my headaches came back immediately. I went through hormone tests, but nothing was significantly off. My progesterone was a little low, but not enough to cause my headaches," Shari says.
Shari tried to put her headaches in the background by focusing on caring for her child. "We always kept our ears open for new treatments for headaches, but I would never get my hopes up. I was willing to try anything, but I tried not to get my hopes up because we were always let down by the results," she says.
That was until one morning in January 2005, when Shari was watching Good Morning America. "They had a segment on a doctor in Dallas who was putting a neurostimulator in patients with headaches. They had three women on the show that had success with the treatment. My mom called me because she was watching it too, so we decided to call the doctor in Dallas," Shari says.
Shari says she knew the Dallas physician's office would be flooded with calls, so she waited a week before calling, telling them her story and faxing her history. A nurse called back and said that she should see Dr. Kenneth Alo in Houston. "He was the one who did the research on headache patients and using a stimulator," Shari says. "I felt like it was meant to be – he was only an hour away from me."
Shari made an appointment with Dr. Alo, who determined that she was a candidate for the surgery. "We went through some procedures to isolate the pain," Shari explains. "Dr. Alo determined that my pain was on the right side of my head, behind my ear." In May, Dr. Alo put in a temporary stimulator. "I woke up the next morning for the first time in 13 years without a headache," Shari says. "When I did get a headache, I turned on the stimulator and it went away within a few hours."
According to Shari, Dr. Alo said, "Let's go for it," and in August 2005, he put in the permanent stimulator. "My life has totally changed. Now I wake up every morning with energy. I'm on the move, I'm ready to go. I can play with my son. I can take care of him. I'm not relying on my mom to help me take care of him anymore. I even feel like I'm ready to go back to work," Shari says. "I still have headaches but I turn the stimulator on and they go away." Dr. Alo couldn't guarantee that the stimulator would stop Shari's migraine, but it has definitely helped. She still gets migraines but they are better controlled with the help of the stimulator.
"My life has just changed so much," Shari says. "I'm losing weight, I'm active. I'm being a normal housewife. I can do the everyday things that most people take for granted that I just couldn't do, like cooking dinner for my family." Shari says she's still working through some issues and is trying to make up for lost time. "I'm a better wife now, too, because our relationship has suffered. Everything has suffered. Now, I'm trying to mend fences with my family because I've gotten a lot of the attention – not that I meant to, but my mom's attention was focused on me."
Shari's goal right now is to get the word out there for people who are like her. "My mission is to get the word out there to other headache patients that there is hope," she explains. "If I can do anything to get the word out there to let other people know, I'm willing to step out of my box to bring attention to myself to let others know that this device is out there and it may or may not help someone else." She's been writing to pain organizations and her local news organizations to make others aware of the treatment. "I need to tell people about it so that at least I know I'm doing something and that's very important to me right now."
Recurring headaches, however, are a real problem for an estimated 60 million to 80 million Americans. More than 29 million people in the United States suffer from migraine, a type of headache that can be chronic and incapacitating, interfering with school, work, relationships, and life. Migraine affects women three times more often then men and often is misdiagnosed. Most people who experience migraine have a family history of the disorder.
For people with migraine, finding the right treatment can change their lives. For some people, avoiding triggers such as drinking wine or eating certain cheeses or even making sure they get adequate sleep helps prevent migraine. For others, preventive medications help and medications called "triptans" can help an individual manage their migraine attacks and lead normal lives.
For some people, no matter how hard you try, how many triggers you avoid, how many doctors you visit, how many medications you take, how many alternative treatments you try, migraine takes a hold of your life and won't let go.
When this happens, it's called transformed migraine and 5-7% of people with migraine develop this type of headache. People with transformed migraine have a history of migraine attacks that become more frequent and eventually become a chronic daily migraine headache with a daily or near-daily background headache that feels like a typical tension headache.
In the past, migraines were considered vascular – or blood vessel-related – headaches. They were thought to occur when shifts in blood flow suddenly expanded the blood vessels in and around the head, causing pain. Now, the most current and respected findings suggest that migraines and other primary headaches arise from disturbances within the central nervous system. These disturbances trigger a cascade of chemical changes that cause inflamed blood vessels and neurological symptoms, including pain. Because of these findings, there may be new treatments for migraine.
"Right now, there is no good treatment for transformed migraine," says Dr. Kenneth Alo, a pain specialist in Houston. He and his colleagues hypothesized that transformed migraine may respond to peripheral nerve stimulation because of the neuropathic nature of transformed migraine symptoms in some patients.
Classic migraine treatments are directed at the blood vessels but have no effect on neuropathic pain (nerve pain). Peripheral nerve stimulation is effective for many people with neuropathic pain. "Some transformed migraine is like nerve pain – it's sort of like sciatic nerve pain. That's the reason why the drugs don't work," Dr. Alo explains. "Stimulators control the nerve pain, and that's why it controls the pain of transformed migraine in some patients."
For Shari Wendt, a 32-year-old mother in Texas, life became "pure hell" because of transformed migraine – until she found some relief with a neurostimulator.
Shari says she was a normal teenager growing up who sporadically had headaches and migraine. She went to her local doctor, who prescribed medication, but it never really helped. In 1993, Shari's headaches took a turn for the worse while she was in college. "I contracted meningitis. They didn't know which type it was, and I ended up in the hospital for 10 days," Shari explains. "Ever since then – every single day of my life – I've woken up with a splitting headache. I was a teenager, and I lost my life. I couldn't do the things normal teenagers do," Shari says.
Shari visited neurologists in the Houston area and tried "tons of different types of medications over the years but none of it worked," she says. She entered a specialized headache program and followed the protocol but found no relief. "I missed out on a lot. I spent a lot of time in bed because I was on heavy narcotics and pain shots. I went from neurologist to neurologist, hoping that someone could help me. I was willing to try anything," Shari says. But nothing worked.
Finally, one doctor diagnosed Shari with three types of headaches – daily chronic headache, migraine, and pseudotumor cerebri, a condition where cerebrospinal fluid builds up around the brain. "He was the only one who could give me an answer to what was going on, but he only offered more medications and those didn't work," Shari explains.
Shari says she was determined to finish college and she did, though it wasn't easy. "All I ever wanted to do with my life was be a teacher," she says. "I think that's just what kept me going because I was in so much pain. I'm the type of person who – when I have a vision – I'm not happy with myself until I get it done. I made it through, but I missed out on a lot. I missed a lot of classes, but I graduated with honors. I had to take so much medication, but I got it done."
Shari calls that time in her life "pure hell." She lost friends and became distant from family members. "My mom stood by me – she was there with me through everything because she was the only one who could sympathize with me – she had migraines and knew what the pain was like. I don't like to relieve those years because I'm not the type of person to say 'Oh, poor me,' but it really was pure hell," she explains. "I wasn't able to go to my sister's wedding. My family life suffered."
Shari did get married in 1997 to a man who has stood by her through it all. She began her career in the Houston area, where she taught for six years. "My work kept me going, but it also suffered because I missed a lot of work," she says. "When you're a teacher, you have to be there every day for those kids."
In 2002, everything came to a boiling point. Shari says she was missing a lot of work and her family was worried about the amount of pain medication she was taking every day. "My husband and my mother stepped in and told me I had to quit," Shari explains. "I gave up my job and focused on getting off the pain medicine, which helped a lot because I was having rebound headaches from all the medications."
Shari says she still didn't have much of a life, but was feeling slightly better. "I felt like I was 30 years old and life was passing me by. I really wanted to have children, so we decided to get pregnant. Like I said, I have a one-track mind and I was determined. I'm going to have a child, I'm going to take care of it, and it was going to take my mind off of my pain," she says.
During her pregnancy, Shari's headaches were rare so everyone thought the headaches were related to her hormones. Unfortunately, hormones were not the answer. "After I had my child, my headaches came back immediately. I went through hormone tests, but nothing was significantly off. My progesterone was a little low, but not enough to cause my headaches," Shari says.
Shari tried to put her headaches in the background by focusing on caring for her child. "We always kept our ears open for new treatments for headaches, but I would never get my hopes up. I was willing to try anything, but I tried not to get my hopes up because we were always let down by the results," she says.
That was until one morning in January 2005, when Shari was watching Good Morning America. "They had a segment on a doctor in Dallas who was putting a neurostimulator in patients with headaches. They had three women on the show that had success with the treatment. My mom called me because she was watching it too, so we decided to call the doctor in Dallas," Shari says.
Shari says she knew the Dallas physician's office would be flooded with calls, so she waited a week before calling, telling them her story and faxing her history. A nurse called back and said that she should see Dr. Kenneth Alo in Houston. "He was the one who did the research on headache patients and using a stimulator," Shari says. "I felt like it was meant to be – he was only an hour away from me."
Shari made an appointment with Dr. Alo, who determined that she was a candidate for the surgery. "We went through some procedures to isolate the pain," Shari explains. "Dr. Alo determined that my pain was on the right side of my head, behind my ear." In May, Dr. Alo put in a temporary stimulator. "I woke up the next morning for the first time in 13 years without a headache," Shari says. "When I did get a headache, I turned on the stimulator and it went away within a few hours."
According to Shari, Dr. Alo said, "Let's go for it," and in August 2005, he put in the permanent stimulator. "My life has totally changed. Now I wake up every morning with energy. I'm on the move, I'm ready to go. I can play with my son. I can take care of him. I'm not relying on my mom to help me take care of him anymore. I even feel like I'm ready to go back to work," Shari says. "I still have headaches but I turn the stimulator on and they go away." Dr. Alo couldn't guarantee that the stimulator would stop Shari's migraine, but it has definitely helped. She still gets migraines but they are better controlled with the help of the stimulator.
"My life has just changed so much," Shari says. "I'm losing weight, I'm active. I'm being a normal housewife. I can do the everyday things that most people take for granted that I just couldn't do, like cooking dinner for my family." Shari says she's still working through some issues and is trying to make up for lost time. "I'm a better wife now, too, because our relationship has suffered. Everything has suffered. Now, I'm trying to mend fences with my family because I've gotten a lot of the attention – not that I meant to, but my mom's attention was focused on me."
Shari's goal right now is to get the word out there for people who are like her. "My mission is to get the word out there to other headache patients that there is hope," she explains. "If I can do anything to get the word out there to let other people know, I'm willing to step out of my box to bring attention to myself to let others know that this device is out there and it may or may not help someone else." She's been writing to pain organizations and her local news organizations to make others aware of the treatment. "I need to tell people about it so that at least I know I'm doing something and that's very important to me right now."