headache specialists, and the patients who are poorly
responsive to current therapies, new treatments are
constantly being sought for the management of
migraine. One such treatment is migraine trigger side
deactivation surgery (MTSDS). MTSDS is a term that
encompasses four procedures that are performed based
on the onset location of migraine headache pain:
1. If the migraine starts around the nose/sinuses, surgery
is performed to straighten a deviated nasal septum.
2. If the headaches start around the eyes,
forehead muscles are surgically removed.
3. If the headaches start around the temples, a portion
of a nerve in the temples is cut and removed.
4. If the headaches start around the back of the
head, a massive incision is made in the back of
the head, a piece of neck muscle is removed,
and the neighboring nerves are padded
with fat before the incision is closed.
The underlying principle behind these
surgeries is that a compressed nerve is what
is triggering the migraine attacks.
A general principle of medicine is that surgery should
only be pursued when conservative management with
medication has failed, or in emergency situations when
failure to perform surgery can lead to devastating
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outcomes, including death. Although oral medications
and BTX can have temporary side effects, stopping these
treatments will lead to resolution of the side effects.
My mentor and colleague, Doctor Michael Cutrer at
Mayo Clinic, Rochester, MN, once said, “When you
cut through a pain sensitive structure, chances are good
that the pain will probably get worse.” Unfortunately,
in the case of MTSDS, once the surgery has been
performed, there is no way to undo the procedure.
At times, MTSDS can result in complications,
including cosmetic disfigurement, worsening pain,
permanent numbness, and permanent itching.
In addition to complications, the studies that have
been performed to date have not shown any clear
data demonstrating the effectiveness of MTSDS.
In the analysis of the data, there was significant
manipulation of the statistics in an attempt to skew
weak supporting data into significance. Many of the
patients enrolled in these poorly constructed studies
had infrequent headaches, and may not have failed
conservative treatment with migraine medications. For
example, surgery was performed on subjects with less
than 5 headache days per month, which could have
potentially been treated effectively with a symptomatic
medication, such as sumatriptan, and behavioral
Volume 4, Issue 1 • 2014
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