Posts Tagged headache
Ann Arbor, Mich. — Though it’s known that a simple plastic surgery procedure can help some migraine headache sufferers, relatively few U.S. plastic surgeons are performing it, a new study reports. Researchers from the University of Michigan surveyed nearly 3,500 members of the American Society of Plastic Surgeons about their knowledge, attitudes and experience related to migraine surgery. After analyzing responses from nearly 200 surgeons, investigators found that only 18 percent had performed migraine surgery — and that of that group, more than 80 percent said the surgery improved their patients’ symptoms.
Among the survey’s findings:
• Sixty percent of respondents said they would be interested in offering migraine surgery if an appropriate patient were referred to them by a board-certified neurologist.
• Many surgeons surveyed said they didn’t feel familiar enough with migraine surgery techniques — or with migraines in general — to perform the procedure.
• Most respondents said they were unaware that migraine surgery is covered by some major health insurers, including Medicare.
I find the lay press impressions of why plastic surgeons do or do not choose to do certain operations amusing. The key item that neither the ASPS survey nor the lay press impressions of it have addressed is the issue of risk versus benefit.
If this procedure was well-covered by any payer then plastic surgeons would be lining up to perform it. If it had a good risk: benefit profile, the same would be even more true.
Most surgeons trained in programs in which key principles were taught regarding operating for pain. Operations for pain tend to hurt the surgeon more than they relieve the patient.
It was not really mentioned in this piece that a relatively easy alternative to surgery for migraine headaches is Botulinum toxin injections. They work well and are much lower risk than any surgical procedure. I perform them for my wife and they relieve her headaches a great deal.
John Di Saia MD
TRENTON — Minors in New Jersey wouldn’t be able to get Botox injections unless a doctor says it’s medically necessary and documents the reason, under a bill moving through the Assembly. The Assembly Health and Senior Services Committee approved legislation Thursday to clamp down on doctors injecting people under 18 with botulinum toxin for cosmetic purposes. The Federal Drug Administration already bars anyone under 18 from getting Botox for cosmetic reasons. The new state legislation would go further by requiring doctors to document in a patient’s chart the noncosmetic medical reason for performing the procedure on a minor. Botox is used widely to smooth out facial wrinkles, but also can be used to treat headaches and spasms.
This prospective law in New Jersey would make Botox injections illegal in minors without a doctor’s statement that it is medically necessary. Unfortunately this is not to say such a law would have the desired effect. There are docs who will write those “permit slips.” Watch how many of these Botox-using minors get headaches.
I am not really a fan of laws restricting the flow of medicines. I do not believe they work well. Then again cosmetic treatments in minors are on the rise and as a practitioner I can only do what I feel is right in my own office. These minors aren’t getting their Botox treatments from me.
I have stated before the real lack of reason in using Botox and other wrinkle fighters in patients who are too young to have wrinkles. Would such a law affect the use of other treatments? There are other botulinum toxins. What about fillers? We’ll see if this bill goes anywhere.
John Di Saia MD
Federal health officials approved the wrinkle-smoothing injection Botox for migraine headaches on Friday, giving drugmaker Allergan clearance to begin marketing its drug to patients with a serious history of the condition. The FDA approved the new use based on two company studies of more than 1,300 patients who received either a Botox injection or a dummy injection. Patients who received Botox reported slightly fewer “headache days” than patients given the sham treatment.
This reminds me of the media blast when Botox was approved for cosmetic wrinkle reduction. I have been using Botox and other botulinum toxins since 1997 off label. It was plainly apparent years ago that migraine patients had fewer headaches and they would come for both the cosmetic benefit and the headache treatment at the same three month interval.
The FDA will not tell you that Botox and the other toxins work very similarly. I have been using Myobloc for my patients for years and I actually like it better. It works well for migraines too although as a plastic surgeon I am only supposed to give it for wrinkles. Kinda silly.Although we have used it for Migraines for years, only now is Allergan allowed to market it to migraine patients. That is silly too.
John Di Saia MD