Ahmed M. Afifi - Surgical Treatment of Chronic Headaches and Migraines

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Listening to patients and learning from their observations led me to research and describe the contemporary surgical techniques for the treatment of chronic headaches going back to late 1999. The investigations to prove the concept and improve the results have continued over the past 20 years. The evolution of this field has been the most exhilarating aspect of my professional career. Sharing the information I have gleaned with others throughout the world and developing a whole new subspecialty of plastic surgery where surgical talents can be applied to eliminate dreadfully painful condition have become the most fulfilling part of my life.

For those who do not suffer from migraine headaches, understanding the magnitude of what these patients endure is difficult. Even minor headaches can ruin an entire day. Those who writhe at the insignificant, yet annoying, ache can appreciate the enormity of what these patients who have chronic, daily migraine headaches tolerate. Those of us who care for these people repeatedly hear from them that we are their last resort, and should we fail to help them, they prefer not to continue living. The role of the plastic surgeon in eliminating deformities to render affected individuals presentable to society, help them enjoy their lives, and be accepted by their peers has been recognized to some degree. However, prevailing opinions about plastic surgeons are that they deal mostly with vain and frivolous concerns. Elimination of pain through peripheral nerve surgery has not been acknowledged by the lay public to the degree that it should. I am hopeful that by propagating information about migraine/headache surgery, the public will become more aware of how great an impact plastic surgeons can make in altering the quality of life of so many patients.

It is remarkably gratifying to see so many younger colleagues enthusiastically embrace this surgical field. They are not only eager to learn and implement these headache operations but seem to be emboldened with a sincere desire to improve the lives of so many. The growing number of surgeons keen to distribute their personal knowledge and experience through this book and previously published books is a resolute testimony to the efficacy of the operations described herein, despite initial disbelief among some of our other medical colleagues. Over the years, collectively, we have offered enough evidence for those skeptics to become convinced that our success neither is a placebo effect nor is it transient. We now have patients who have been followed for close to 18 years with no migraine symptoms and no chronic headaches. There are very few surgical procedures that have been scrutinized through rigorous studies including a retrospective analysis, prospective pilot study, prospective randomized trial with comprehensive inclusion of different trigger sites, and prospective, randomized study with sham surgery and 5-year follow-up. Through basic science studies involving plastic surgery, neurobiology, and proteomics departments at Case Western Reserve University, we have also demonstrated structural pathology in the peripheral nerves of migraine patients compared with asymptomatic patients. Similarly, recent discoveries from the neurology literature strengthen these findings. Collectively, these results form the foundation for the peripheral concept of chronic headaches, which is now being revisited by some open-minded neurologists.

While initial skepticism could have dissuaded us from our efforts, a firm belief in the validity of the peripheral concept, steadfast determination, and unwavering commitment, fueled by continual positive outcomes, had led to the development of multiple procedures that reduce or eliminate migraine headache pain. We will continue this work and hope that by publishing this text, we can entice more surgeons to incorporate this surgical technique into their practice, with the aim of helping more and more patients, both nationally and internationally.