Anu C Philip had lived with migraines since she was a child till a surgery took her pain away on May 3.
"I started getting migraines when I was 10, but they were not very severe. But in Class 12, they went out of control and became so bad that I was on multiple painkillers every day just to be able to function," says 24-year-old Philip. "The medicines lessened the pain, but it never went away," she adds.
About one in five – or 21% – of migraine patients get their first attack before the age of 10, reported a study in the journal Neurology.
Migraines usually begin as a dull ache in the head or neck and build up to become a throbbing pain on one side of the head. "It usually lasts for hours," says Dr Pushpendra Renjen, neurologist, Apollo Hospitals. "Classical migraines occur in one in three patients, so it’s often mis-diagnosed," he adds.
Fixing the pain
What worked for Philip was an occipital nerves (nerves that run from the spinal cord to the back of the head) decompression surgery.
Since her migraines originated at the base of her neck and were triggered by spasms of the nerve muscle — triggers can be physical stress, neck contraction, flexion or extension, or medical conditions — the surgeons decided to remove a sleeve of muscle from around the nerve to relieve the pressure on it.
"This migraine surgery produces lasting results, with the headaches disappearing completely in one in three patients and 90% reporting major relief even five years after the surgery, according to a study in the Plastic and Reconstructive Surgery," says Dr Sunil Choudhary, head of aesthetic and reconstructive plastic surgery, Max Saket, who led the team that did the surgery.
Migraines are as common as asthma or diabetes, but less than 2% of the estimated 50 million people in India with the debilitating headaches seek treatment.
Usually mild to moderate headaches can be treated and even aborted using inexpensive painkillers, such as aspirin, paracetamol, ibuprofen or naproxen sodium, or by compounds containing caffeine, acetaminophen, and aspirin.
"Severe migraines require stronger medicines such as triptans, naproxen sodium and beta-blockers," says Dr Renjen. One third of patients, however, do not respond to treatments.
Migraine surgery techniques focus on reducing pain by surgically de-activating the trigger sites in the nerves or muscle that produce the pain.
"This surgery is done through a 4-inch incision using the open technique.
There is no obviously visible scar as the cut is under the hairline at the base of the skull. Even simpler cosmetic surgeries such as a forehead-lift help people with frontal migraine headaches," says Choudhary.
Before surgery, patients are tested with botulinum toxin A (Botox) to confirm the correct trigger sites."People who respond to Botox are good candidates for the surgery," he adds.
Botox is a standard but expensive treatment for unresponsive migraines: a 50-to 100-unit shot priced between Rs 15,000 and Rs 30,000 needs to be given every four months. Philip’s surgery is a day-care procedure that costs between Rs 75,000 and Rs 1.25 lakh.
Regular sleep, healthy food and exercise, along with identifying and avoiding migraine triggers, can lower attacks in most people.
"Medicines and surgery are recommended only if avoiding triggers is not possible and migraines occur more than twice a month," says Renjen.