What does a “cure” for migraine mean?

There are going to be a lot of folks who respond to this without reading further, who will insist that there is no cure for migraine headaches, and who don’t want to consider things outside of their personal experience.  The following discussion is for everyone else….

Google the word “cure” and you will find the definition of the verb to be to “relieve (a person or animal) of the symptoms of a disease or condition.”  In thinking of curing migraine disease, many people, particularly the skeptics, feel that nothing short of a pill that everyone takes that makes migraines go away forever in every case and in every patient.  In this picture, there are really very few cures of anything or any disease.  Penicillin is the cure for strep throat, for example, but some patients who get penicillin for strep remain sick despite this therapy.  Is there a cure for high blood pressure?  Many patients who take medication no longer have high blood pressure, but some are resistant to all different kinds of medications. 

For the purposes of this discussion, I would like to compare migraine disease to cancer.  Not to shock, and not to alarm… migraines are NOT cancer.  But when it comes to a cure, there are a lot of similarities.  So let’s talk about thyroid cancer for the time being.  The same discussion to follow can be had for early prostate cancer, early breast cancer, and actually most early cancers that have not yet spread to other areas of the body. 

Many of these cancers listed, and particular early thyroid cancer, can be cured by removing the tumor, or in some cases, part or all of the thyroid gland.  In cases where these cancer tumors are localized and have not spread, they are in the stage where the extent of the cancer remains restricted to the spot where it came from.  For patients in whom their cancer has been found at this early stage, removal of the tumor is often curative.  While there may be no cure for cancer, these patients with cancer have been cured.

Migraine disease, occipital neuralgia, tension headaches, and other chronic headaches should be thought of no differently than this.  For many patients with migraines, a cure is actually possible.  Nerve decompression surgery removes the root cause of the migraine disease.  Excision surgery in early stage cancer removes the tumor.  In either case, for these patients, their disease is cured.  While it may be much easier to understand how removing a tumor can cure cancer, there is a bit more to register in thinking about how nerve decompression can provide a cure for migraines.

We now know that many patients with migraine disease suffer from compression of peripheral nerves in the head and neck that are the actual cause of their migraine headache pain.  Studies published in neurology and pain Journals in the last months are finally supporting these concepts that have been embraced by migraine surgeons for the past several years.[1] We are now seeing data that not only supports nerve decompression for migraine improvement, but anatomic studies are actually mapping nerve commonalities where these peripheral nerves are in communication with the dura, or lining of the brain.[2]  It now just simply makes sense that irritation of these nerves cause pain in the dura of the brain, and a migraine develops.  Not only this, but these nerves are now known to intermingle with those that feed the cerebellum which is responsible for balance and the opposite… dizziness.  Many of the components of migraine headaches are now evident to be the result of compression of the nerves that migraine surgeons address.

So, it makes sense that when these peripheral nerves in the occipital and facial regions are irritated, the pain and other symptoms of migraine in the brain develop.  By decompressing these nerves, preventing the irritation of these nerves, and preventing these nerves from irritating the nerves of the brain lining, the migraine is aborted, and just never happens. No pain, no dizziness, no migraine.  In fact, for many, this outpatient nerve decompression surgery “relieves (a person or animal) of the symptoms of a disease or condition.”  In other words, for many, nerve decompression is the cure for migraine headaches.

Now importantly, nerve decompression is not a cure for everyone.  While over 40% of patients who have migraine surgery never have another migraine and are apparently cured of their migraine disease, another 50% of patients a major improvement in their severity and frequency of their pain.  So in all we see 90% of migraine surgery patients experience a life changing improvement in their headaches, and nearly half of those are actually cured.  Either way most migraine surgery patients will report that they are thrilled that they had the surgery. 

For many, yes, there is a cure for migraine.

REFERENCES

1)Blake, Pamela, and Rami Burstein. “Emerging Evidence of Occipital Nerve Compression in Unremitting Head and Neck Pain.” The Journal of Headache and Pain, vol. 20, no. 1, 2019, pp. 76–83., doi:10.1186/s10194-019-1023-y.