Transcription:
Headache Surgery

Melanie Cole (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical. Keeping you informed so you can make informed healthcare choices for yourself and your whole family.

Back to health features, conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Wei Cornell Medicine, I'm Melanie Cole. Joining me today is Dr. Lisa faa. She's an assistant professor in plastic and reconstructive surgery at Wei Cornell Medicine, and she's here today to tell us about headache surgery.

Dr. Fa, it's a pleasure to have you join us again. So, why are headaches or migraines important to manage and prevent from worsening? we even know what they are or why we get them? Tell us a little bit about some of the challenges associated with treating headaches and what we know about them.

Dr Lisa Gfrerer: Thank you for the great question, Melanie. You know, I think the care for headaches and migraine has really changed over. The last two decades, we always thought that headaches and migraines are just a brain problem, always a brain problem. But over the past 20 years, we've realized that there are other.

Factors that can cause headaches such as nerve compression. There are many nerves around the head that can be compressed between muscle, fascia, blood vessels, and bones. And if that's the case, nerve pain can result and that can trigger really bad migraines And. So oftentimes if patients don't respond to medications and other treatments, then surgery can be performed to release these nerves and prevent, pain from happening.

Melanie Cole (Host): Wow, that is just so interesting. So tell us a little bit about that surgery that we're talking about, because you know, and you mentioned conservative. Measures if medications don't work. But I wanna get right into this topic cuz it's so cool and as I understand it, while Cornell Medicine is one of, if not the only institution doing the procedure in the New York area, so can you highlight this surgery?

Tell us what it is.

Dr Lisa Gfrerer: Of course. So all these nerves travel very superficially in the layers right underneath your skin. so what we do is, we make. small incisions and, we find these nerves and we remove all the tissues that are constricting to the nerves. everything is outside of the skull, so you know, it's not brain surgery.

Everything is outside of the head. and these surgeries are very well tolerated. . What it really reminds me of, which is, something that is more common and a lot of people know about is carpal tunnel, syndrome in the hand where the nerves can get compressed and you have pain in your fingers. So it's a similar surgery to that where you make a small incision and you release the nerve.

Melanie Cole (Host): Now, this may seem like a weird question, but you're talking about doing this nerve surgery and, thank you for saying it's not. You know, invasive that way you're not doing brain surgery, but can you tell us why a plastic and reconstructive surgeon such as yourself is doing this procedure?

Dr Lisa Gfrerer: so my specialty is peripheral nerve. And peripheral nerve surgery means that I treat all nerves in all parts of the body. nerve compression is actually very common in other parts of the body. I mentioned carpal tunnel syndrome, but nerves can be compressed in the legs, in the torso. really anywhere you can think of.

It's just that we have not. consider the nerves of the head and neck before this is kind of new, but essentially, I'm just taking what I've done in other body parts to the head and neck area.

Melanie Cole (Host): Wow, that's really cool. Drta. So which patients are surgical candidates for this? have they had to have tried many other things before this becomes an option? Speak about that patient selection.

Dr Lisa Gfrerer: Yes, so it is important to, have tried medications before, have tried injectables and. Medications and injectables have failed, then you may be a candidate for surgery.

If you have failed medications and you have tried injectables and that has not worked for you, then you may be a candidate for release of your nerves. and you are welcome to come see me, to determine whether or not you're a candidate. for.

Melanie Cole (Host): But they had to have tried all these other conservative measures. Yes.

Dr Lisa Gfrerer: Yes, that's correct. It's always important to try conservative measures first before we think about surgery.

Melanie Cole (Host): Doctor, tell us about the procedure itself. Is this done as an outpatient? What is it like for the patient when they leave? Tell us about that part of.

Dr Lisa Gfrerer: the surgery's outpatient, depending on what site you have surgery on. The surgery can take anywhere between 30 minutes and two hours. but you always go home. A lot of patients wake up and they have. pain at all. in terms of their headaches and migraines, other patients still experience headache and migraines, so we don't really draw any conclusions about outcome until three months after surgery.

As I said, the surgery is quite superficial and is quite well tolerated.

We don't see a lot of complications with this procedure.

Melanie Cole (Host): Then tell us a little bit about after the procedure, how have been your outcomes, doctor, and what have patients said about this? Do their headaches come back? Does it take a while? Tell us about this.

Dr Lisa Gfrerer: if we pick the right patients and I put a lot of time into picking the right patients for surgery, then we get very, very good results. in general around, 70% of patients improve their symptoms after surgery. And most of these patients get much better, meaning over 90% improvement of their symptoms.

So either their headaches and migraines are completely gone, or they, have much fewer headaches or the medications that they're taking now help them more. So overall, it's a, very high success.

Melanie Cole (Host): So what would you like to tell listeners that suffer from headaches? Because it really is debilitating. I am lucky that I'm not somebody who gets them very often and you know, we know people that's like, Somebody gets a headache all the time and some people just really don't get them a lot. What would you like to tell people that do when they should see a specialist for these headaches?

And if you've got any tips or tricks, things they can try to help manage that painful headache.

Dr Lisa Gfrerer: if you are someone who suffers from headaches or migraine, you should definitely be seeing a neurologist because they will evaluate your pain, make sure there's no red flags, make sure you're okay, and then start you on medications that can really help this pain. If you've tried all. and you're still having debilitating pain, then I would encourage you to open your eyes to other treatments such as device based treatments or surgery because they can really help many, many patients.

Melanie Cole (Host): That is so interesting. Doctor, thank you for joining us again. What a great guest you are. And while Cornell Medicine continues to see our patients in person as well as through video visits, You can be confident of the safety of your appointments at Wei Cornell Medicine. That concludes today's episode of Back to Health.

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disclaimer: All information contained in this podcast is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition.

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