Migraine surgery

Migraine surgery

Migraine surgery is any surgical operation undertaken with the goal of reducing or preventing migraines. Innovative surgical techniques have been developed to help patients with migraine headaches. Migraines affect an estimated 10% of the worldwide population annually[citation needed] and cause significant loss of workdays and billions of dollars in productivity.[citation needed] It is well documented[by whom?] that migraine headaches cause significant disability, and reduce of quality of life that is as dire, if not worse than, debilitating chronic diseases.[citation needed] There have been major pharmacological advances for the treatment of migraine headaches, yet patients must still endure symptoms until the medications take effect. Furthermore, often they still experience a poor quality of life despite an aggressive regimen of pharmacotherapy.[1] For these reasons, surgical solutions to migraines are actively being researched, particularly those involving the surgical cauterization of the superficial blood vessels of the scalp (the terminal branches of the external carotid artery), the removal of muscles or nerves in areas known as "trigger sites", and those involving the correction of a congenital heart defect. Despite the lack of evidence supporting migraine surgery, there are over a dozen surgeons[2] actively performing the operations in the US.


Surgical procedures

Arterial surgery

The rationale for arterial surgery for the treatment of migraine is based upon the work done by Harold Wolff and his co-workers in the 1940s. Wolff first subjected the condition of migraine to rigorous scientific experimentation, and showed convincingly that in some migraine sufferers the pain originates in the distended terminal branches of the external carotid artery.[3][4][5][6][7][8] Wolff’s theory has since been confirmed many times.[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] There have been attempts to debunk Wolff's vascular theory,[32][33][34][35][36] and for years it has been out of favor. Recently however, there has been renewed interest in Wolff's vascular theory of migraine led by Elliot Shevel, a South African headache specialist, who has published a number of articles providing compelling evidence that Wolff was in fact correct.[31][37][38][39][40]

Minimally Invasive Arterial Surgery (MIAS)

There is compelling evidence to show that migraine pain often originates in the terminal branches of the external carotid artery.[41][42][43][44][45] In migraine sufferers with extracranial vascular pain, and in whom digital compression of the relevant artery reduces or abolishes the pain, surgical ligation or cauterization of the relevant vessel or vessels provides permanent relief from not only the pain of migraine, but also the associated symptoms such as the aura, light sensitivity (photophobia), sensitivity to sound (phonophobia), nausea, and vomiting.[46] MIAS is highly successful in migraine sufferers where a definite positive diagnosis has been made, by examining the patient while they are experiencing migraine pain. The terminal branches of the external carotid artery are systematically compressed against the underlying tissues to determine exactly which vessels are responsible for the pain. When the relevant vessels are compressed, the pain either diminishes significantly or disappears completely. In this way, a positive diagnosis is made.

Ligation of temporal vessels was first described by Abu al-Qasim al-Zahrawi (936 – 1013 AD), a Moorish physician.[47] Historically, it has been reported that Ambroise Paré (1510–1590 AD), father of modern medicine, ligated his own temporal vessels for relief of his migraines. Since then the efficacy of arterial ablation for migraine treatment by ligation, cryotherapy, or cauterization of the relevant vessels has been confirmed repeatedly.[48][49][50][51][52][53][54][55][56][57][58]

When is arterial surgery indicated?

This treatment modality is of particular value in: 1) patients who have not responded to conventional drug therapy, 2) patients who are unable to use drug therapy because they experience unacceptable side effects, or 3) patients who would prefer not to be on permanent medication. Included in this category are those with Chronic Daily Headache (headache on more than 15 days per month) and patients with what is known as "refractory headache" - headache that has not benefited from any other form of treatment. A recent study has shown that patients with chronic migraine experienced a significant reduction in pain levels and significant improvement in their quality of life following the surgery.[59] The most common vessels involved in the pain of migraine are the terminal branches of the external carotid artery, and in particular, the superficial temporal artery and its frontal branch, and the occipital artery. These vessels are subcutaneous and the small incisions required to access them mean that the surgery is minimally invasive and can be done in a day facility. As these vessels have no connection with the arterial supply to the brain, MIAS is exceedingly safe with no unpleasant side effects. The cosmetic effect is excellent as most of the incisions are within the hairline.

How do we diagnose who will benefit from arterial surgery?

There are a number of methods used to diagnose whether arterial surgery will be of benefit.

1) There are certain scalp arteries that most commonly cause the pain of migraine. These are compressed with the fingertip during an attack. If blocking the artery by pressure relieves the pain temporarily, and the pain returns when the finger pressure is removed, then arterial surgery is indicated.[60]

2) Some migraine sufferers get relief from tying a tight band round the head just above the eyes and ears. This closes off the arteries that are causing the pain. If a tight band provides relief, then the surgery is indicated.[61]

3) Certain medications provide relief from migraine pain by constricting or narrowing the scalp arteries. If these medications give relief, then the arterial surgery is indicated.[62] These medications include the:

a) Triptans, namely sumatriptan (Imitrex, Imigran, Cinie, Illument, Migriptan), zolmitriptan (Zomig), eletriptan (Relpax), rizatriptan (Maxalt), frovatriptan (Frova, Migard, Frovamig), naratriptan (Amerge, Naramig), avitriptan (BMS-180,048), and almotriptan (Axert, Almogran).

b) Ergots. Any medications that contain ergotamine or dihydroergotamine.

Trigger site release

It has been theorized that trigger sites (TSs) exist where sensory nerves are being stimulated by a surrounding muscle or specific contact points. Due to this nerve irritation, a cascade of events is initiated, leading to the inflammation of the meningeal layers surrounding the brain, and to migraine headaches.

Thus far, four trigger areas have been identified as surgical candidates. Three of these are in locations where the nerve passes through a muscle—where the greater occipital nerve pierces through the semispinalis capitis muscle, the zygomaticotemporal nerve through the temporalis muscle, and the supraorbital/supratrochlear nerves through the glabellar muscle group (the corrugator supercilii, depressor supercilii, and procerus muscles).[63][64][65] The fourth trigger point, however, has been identified in the nose of patients who have significant nasal septum deviation with enlargement of the turbinates.[64] The contact between these structures causes the irritation of the trigeminal nerve end branches and thus triggers migraine headaches. Several large series of studies have been conducted to evaluate the efficacy of surgical obliteration of trigger points. Almost all demonstrated more than 90% response, with at least 50% improvement to complete resolution of migraine pain symptoms.

This type of migraine surgery is not offered as a first line of treatment, but after extensive evaluation and failure of traditional medical treatments.[64][66][67] Trials are still ongoing to standardize the procedures of choice for definitive management of migraine headaches, but there have been successful guidelines for surgical therapy, which are being used by several migraine surgery specialists around the globe.[citation needed] Currently this treatment has institutional approval for adults, and trials for the pediatric population are ongoing.[citation needed]

Details of the procedure

Patients have to be screened preoperatively with a full neurological examination, and subsequent Botox injection and/or nasal endoscopy. A positive response to Botox has been a positive predictor of a successful outcome. Single or multiple TSs may be treated. Migraine headaches can start in one area depending on their corresponding trigger site and spread to the rest of the head. It is important to identify the initial trigger sites rather than address all the areas of pain, after the inflammation involves the entire trigeminal tree. Four different types of migraine have been defined based on their trigger point location, and are addressed individually. Sometimes the alleviation of one trigger site results in the unmasking a second site.

Forehead migraine headaches: In the glabellar area the supra-orbital and supra-trochlear nerves are skeletonized by resecting the corrugator and depressor supercilii muscle using an endoscopic approach similar that of used for cosmetic forehead lift.

Temporal migraine headaches: The temporal area, where the zygomaticotemporal branch of trigeminal nerve passes through the temporalis muscle, is addressed using a similar endoscopic approach but involves removing a segment of the nerve rather than transecting the muscle. This results in a slight sensory defect over temporal skin area, but cross-innervation from other sensory nerves helps to limit the damage.

Rhinogenic migraine headaches: The nasal trigger points where enlarged turbinates are in contact with the nasal septum are addressed with a septoplasty and a turbinectomy.

Occipital migraine headaches: The posterior neck area where the greater occipital nerve passes through the semispinalis capitis muscle is addressed with an open surgical approach with resection of a small segment of the semispinalis muscle and shielding the nerves with a subcutaneous adipose flap.[64]

Patent foramen ovale closure

Several clinical trials are currently under way in an effort to determine the existence of a causal linkage between migraines and the presence of a patent foramen ovale (PFO), a hole between the upper chambers (the atria) of the heart. There is significant evidence that a link exists between migraine with aura and the presence of a PFO.[68]

It is estimated that 20-25% of the general population in the United States has a PFO.[69][70] Medical research studies have shown that migraineurs are twice as likely as the general population to have a PFO,[68][69] that over 50% of sufferers of migraine with aura have a PFO,[68] that patients with a PFO are 5.1 times more likely to suffer from migraines and 3.2 times more likely to have migraines with aura than the general population,[68] and that patients with migraine with aura are much more likely to have a large opening than the general PFO population.[68][70][71]


The foramen ovale (literally oval hole) is present in all fetuses. Because a fetus' blood is oxygenated through the mother's placenta and not through breathing, the pulmonary system is unneeded. To make the fetal circulatory system more effective, the hole exists so that blood can travel from the right atrium to the left atrium without entering the pulmonary circulation. When the baby is born and begins breathing, the resistance in the lungs decreases dramatically, and blood begins to travel into the pulmonary system. This results in increased pressure in the left atrium, which then forces the flap down and effectively seals the hole. Once fully fused, the resulting structure is called the fossa ovalis (literally oval ditch). If the hole is not fully sealed, it is said to be patent (literally open).

Pathophysiological theories

In certain scenarios, such as when a person sneezes, the pressure in the left atrium decreases and the flap over the still-present foramen ovale opens temporarily. When this happens, blood is able to bypass the lungs and therefore the filtration process in the pulmonary system. There are at least 4 theories as to how this defect leads to migraines.[70]

Toxic circulation

Early speculation regarding this link centered on the idea that, because blood bypasses the detoxificaiton process in the lungs and reenters the circulatory system uncleaned, this "toxic blood" may contain various substances that then trigger migraines.[70][72] There is speculation that one of these substances is 5-HT, more commonly known as serotonin. Normally, 5-HT is filtered in the pulmonary circulation. However, if blood is bypassing that filtration process, 5-HT can re-enter systemic circulation and travel to and enter the brain. Numerous studies have related 5-HT to migraine pathogenesis, and the current pharmacological treatment of choice is a triptan drug, which binds to serotonin receptors in the brain and leads to the migraine being cured. This evidence lends support to the theory that 5-HT is one of the substances that triggers a migraine in a patient with a PFO.[70][73]


There is speculation that microemboli that develop in the venous system pass through the PFO and are able to reach the central nervous system.[68][70] The paradoxical embolism then reaches the cortex, triggering cortical spreading depression, a phenomenon that leads to migraines. There is also evidence that the number of gas bubbles in a paradoxical gas embolism is correlated with the severity of the headache.[74]

Genetic linkage

One study has found a genetic linkage between migraines and PFOs.[71] It was found that PFOs have an autosomal dominant pattern of inheritance, and that migraine with aura appears to be coinherited in some families.

Atrial natriuretic peptides

It has been shown that the changes in interarterial pressure that occur with a PFO cause an increase in atrial natriuretic peptide (ANP), and that the ANP concentration in migraineurs with aura is lower than the concentration in control subjects. A study has shown that when the cortical spreading depression phenomenon was induced in mice, ANP was expressed in the brain.[75] As well, ANP levels are elevated in patients with a PFO.[75] All together, this suggests a possible correlation between ANP concentration and migraine with aura.[75]


It has been shown that migraine frequency and severity is reduced if the hole is patched surgically.[76] Mark Reisman, cardiologist at Seattle's Swedish Medical Center explained an advantage to non-pharmacological migraine relief. He said, "In contrast to drugs, PFO closure appears highly effective against migraines and usually has no side effects".[77] Because PFO closure continues to prove successful, new devices are being produced to make the surgery easier to perform and less invasive.

Recent studies, however, have emphasised caution in relating PFO closure surgeries to migraines, stating that the favourable studies have been poorly-designed retrospective studies and that insufficient evidence exists to justify the dangerous procedure.[78][79] As well, at least one patient with infrequent migraines who underwent the surgery ended up with daily migraines for at least 6 months,[75] and others have reported short-term increases in migraine frequency and intensity following the surgery.[80][81][82]

Coherex FlatStent Closure System

From Coherex Medical Inc. of Salt Lake City, a device called the Coherex FlatStent PFO Closure System is being tested as a new product for PFO closure. This device is first being studied by a European clinical study in Frankfurt, Germany. If this study proves to be a success, the device will begin to undergo FDA approval.[83] The Coherex Closure System is an alternative to the typical method of repairing a PFO by placing a disk on each side of the defect and clamping them together to form a solid wall. The typical method doesn't always work particularly well with PFOs because the lengths, widths and dimensions of the defect are always different. The Coherex device is small and looks delicate, although it's not. One of its unique features is that it's deployed inside the tunnel of the PFO, so it closes the defect from within Because of its construction, it adapts to a PFO's individual shape in terms of length and width, thus avoiding the typical problem with PFO closure. Besides pulling the opening closed, it has a sponge polymer that encourages tissue to grow into it and integrate it into the heart's structure.[citation needed]


Another closure system is in use right now called CardioSEAL.[84] This device looks like a small umbrella made out of Dacron fabric and folded into a special catheter. This catheter is inserted into a vein in the leg like the Coherex device. In order to close the PFO valve, each umbrella opens up and the device is pushed out of the catheter. The device is absorbed into the heart as the heart tissues grow over the implant in time.[85]


Another device for PFO Closure is called the AMPLATZER PFO Occluder device.[84]

It consists of two wire mesh discs filled with polyester fabric. It is folded into a special delivery catheter, similar to the catheter used during a catheterization. The catheter is inserted into a vein in the leg, advanced into the heart and through the defect.

When the catheter is in proper position, the device is slowly pushed out of the catheter until the discs of the device sit on each side of the defect (like a sandwich). The two discs are linked together by a short connecting waist. The discs and the waist are filed with polyester fabric to increase the device’s closing ability.

Over time, heart tissue grows over the implant, and it becomes part of the heart. The tissue grows over the device over time.[86]

Premium trial

University of Washington Medical Center tests the effectiveness of PFO closure in eliminating migraines in a clinical trial called the Premium Trial.[87] All patients must meet certain criteria to qualify for the study including a diary that recounts the severity and frequency of migraines and undergoing tests to eliminate other medical reasons for migraines. A random selection process is then used to determine which patients have their PFO repaired and which ones do not. After a year, the patients will find out if they had the actual procedure and physicians will be able to determine if the process really worked.

The surgery is not performed by cutting open the chest and working on the heart. Instead, a catheter is pushed up to the hole in the heart after it is inserted in a vein in the leg. In order to keep the study blind, all patients are blindfolded and wear headphones while being mildly sedated. All patients receive a catheter in the leg, but not all catheters are pushed up to the heart.

ESCAPE migraine trial

One clinical trial being undertaken began in October 2007 called the ESCAPE Migraine trial to test the relation to PFO closure to migraine relief. Feldman, along with Dr. Susan Rubin, are co-principal investigators of the trial. “The clinical trial expects to enroll 500 patients in the U.S. who have not found relief from migraines with preventive medicine, have experienced unwanted side effects from drug therapy or have been advised by a doctor against medications due to another condition”.[88] This trial will use the closure system called the Premere PFO Closure System that uses the catheter system in the leg to go to the heart. This closure system was designed by St. Jude Medical but is only available for this clinical trial because it has not been approved by the Food and Drug Administration. The study is closed to new participants and has completed final data collection for its primary outcome. Results are expected to be released in fall of 2013.[89]

The procedure involves two-thirds of the patients who had their PFO closed, while the other third had a tube placed in their heart to measure the size of their PFO. The risk of migraine is related to the size of the PFO. Patients will not know until the end of the trial if they were assigned to receive PFO closure. Once the trial is complete, trial participants will meet with a cardiologist for a heart evaluation and a neurologist to evaluate and monitor their migraines after intervention. They were asked to maintain an electronic journal of their migraines for one year. The apparent relation between an opening of the PFO valve and migraines may receive further validation through this study.

Spinal cord stimulation

Spinal cord stimulators are medical stimulators implanted in the region of the spinal cord. They are sometimes used in cases of severe migraine headache on patients who tend to have multiple attacks per month.[90]

Non-surgical procedures

Botulinum neurotoxin A (BoNT-A, popularly known as Botox) injections have been reported by various headache specialists as a potential treatment for migraines.[91][92][93][94][95][96][97][98]

In 2008, a subcommittee of the American Academy of Neurology (AAN) assessed the effectiveness of botulinum toxin in numerous disorders, with one report focusing on autonomic disorders and pain, including 'chronic daily headache'—they noted that this group's headaches were "mainly transformed migraines", and 'chronic tension-type headaches' were not included—and 'episodic migraines'.[96] For chronic daily headaches, four studies were analyzed where the reduction in headache frequency when injected with BoNT-A was compared to a placebo-injected control group. While two of these studies showed favourable results,[97][98] others observed no significant benefits.[99][100] The AAN has thus reported that they can not yet draw any conclusions on the effectiveness of BoNT-A injections in chronic daily headaches.[96] It was noted that, in one study where subjects were stratified based on whether or not they were currently being treated with a prophylactic medication, patients who were not taking prophylactic medications concomittantly fared significantly better than those who were.[96][98]

In the same report, the AAN concluded that the injections were "probably ineffective" in treating episodic migraines. Other studies have reached the same conclusion.[94][95]

Studies examining the effectiveness of BoTN-A injections that were not included in the AAN report have yielded positive results.[91][92][93][94][95] It has been noted, however, that repeated injections are required to keep the headaches under control—the BoTN-A may have a cumulative effect—and they do not address the headaches which are triggered from the septum and turbinates.[92][97]


  1. ^ Jensen, R.; Stovner, L. J. (2008). "Epidemiology and comorbidity of headache". The Lancet Neurology 7 (4): 354–361. doi:10.1016/S1474-4422(08)70062-0.  edit
  2. ^ http://themigrainesurgery.com
  3. ^ Clark D, Hough H, Wolff HG (1934). "Experimental studies on headache". A Research Nerv. and Ment. Dis 15: 417. 
  4. ^ Graham JR, Wolff HG (1938). "Mechanism of migraine headache and action of ergotamine tartrate". Arch. Neurol. Psychiat 39: 737–763. 
  5. ^ Schumacher GA, Wolff HG (1941). "Experimental studies on headache: A. Contrast of histamine headache with the headache of migraine and that associated with hypertension. B. Contrast of vascular mechanisms in pre-headache and in headache phenomena of migraine". Arch. Neurol. Psychiat 45: 199–214. 
  6. ^ Wolff HG, Tunis MM (1952). "Analysis of cranial artery pressure pulse waves in patients with vascular headache of the migraine type". Trans. Assn. Am. Phys 65 (5): 240–244. PMID 12985578. 
  7. ^ Wolff HG, Tunis MM, Goodell H (1953). "Evidence of tissue damage and changes in pain sensitivity in subjects with vascular headaches of the migraine type". Arch. Int. Med 92: 332–341. PMID 13136278. 
  8. ^ Tunis MM, Wolff HG (1953). "Long term observations on the reactivity of the cranial arteries in subjects with vascular headaches of the migraine type". Arch. Neurol. Psychiat 70 (5): 551–557. PMID 13091503. 
  9. ^ Brazil P, Friedman AP (1956). "Craniovascular studies in headache; a report and analysis of pulse volume tracings". Neurology 6 (2): 96–102. PMID 13288761. 
  10. ^ Ostfeld AM, Chapman LF, Goodell H, Wolff HG (1957). "Studies in headache; summary of evidence concerning a noxious agent active locally during migraine headache". Psychosom Med 19 (3): 199–208. PMID 13432093. 
  11. ^ Iversen HK, Nielsen TH, Olesen J, Tfelt-Hansen P (1990). "Arterial responses during migraine headache". Lancet 336 (8719): 837–839. doi:10.1016/0140-6736(90)92339-J. PMID 1976878. 
  12. ^ Elkind AH, Friedman AP, Grossman J (1964). "Cutaneous Blood Flow in Vascular Headaches of the Migraine Type". Neurology 14: 24–30. PMID 14112444. 
  13. ^ Sakai F, Meyer JS (1978). "Regional cerebral hemodynamics during migraine and cluster headaches measured by the 133Xe inhalation method". Headache 18 (3): 122–132. doi:10.1111/j.1526-4610.1978.hed1803122.x. PMID 669942. 
  14. ^ Sakai F, Meyer JS (1979). "Abnormal cerebrovascular reactivity in patients with migraine and cluster headache". Headache 19 (5): 257–266. doi:10.1111/j.1526-4610.1979.hed1905257.x. PMID 468531. 
  15. ^ Olesen IJ, Gulbenkian S, Valenca A (1995). "The peptidergic innervation of the human superficial temporal artery: immunohistochemistry, ultrastructure, and vasomotility". Peptides 16 (2): 275–287. doi:10.1016/0196-9781(94)00165-0. PMID 7540293. 
  16. ^ Goadsby PJ, Edvinsson L (1993). "The trigeminovascular system and migraine: studies characterizing cerebrovascular and neuropeptide changes seen in humans and cats". Ann Neurol 33 (1): 48–56. doi:10.1002/ana.410330109. PMID 8388188. 
  17. ^ Goadsby PJ, Edvinsson L, Ekman R (1990). "Vasoactive peptide release in the extracerebral circulation of humans during migraine headache". Ann Neurol 28 (2): 183–187. doi:10.1002/ana.410280213. PMID 1699472. 
  18. ^ Jansen I, Edvinsson L, Mortensen A, Olesen J (1992). "Sumatriptan is a potent vasoconstrictor of human dural arteries via a 5-HT1-like receptor". Cephalalgia 12 (4): 202–205. doi:10.1046/j.1468-2982.1992.1204202.x. PMID 1326402. 
  19. ^ Petersen KA, Lassen LH, Birk S, Lesko L, Olesen J (2005). "BIBN4096BS antagonizes human alpha-calcitonin gene related peptide-induced headache and extracerebral artery dilatation". Clin Pharmacol Ther 77 (3): 202–213. doi:10.1016/j.clpt.2004.10.001. PMID 15735614. 
  20. ^ Ostergaard JR, Mikkelsen E, Voldby B (1981). "Effects of 5-hydroxytryptamine and ergotamine on human superficial temporal artery". Cephalalgia 1 (4): 223–228. doi:10.1046/j.1468-2982.1981.0104223.x. PMID 7347625. 
  21. ^ Ferrari MD, Saxena PR (1993). "Clinical and experimental effects of sumatriptan in humans". Trends Pharmacol Sci 1993 (4): 129–133. PMID 8390743. 
  22. ^ Doods H (2001). "Development of CGRP antagonists for the treatment of migraine". Curr Opin Investig Drugs 2 (9): 1261–1268. PMID 11717813. 
  23. ^ Olesen J, Diener HC, Husstedt IW (2004). "Calcitonin gene-related peptide receptor antagonist BIBN 4096 BS for the acute treatment of migraine". N Engl J Med 350 (11): 1104–1110. doi:10.1056/NEJMoa030505. PMID 15014183. 
  24. ^ Petersen KA, Birk S, Lassen LH (2005). "The CGRP-antagonist, BIBN4096BS does not affect cerebral or systemic haemodynamics in healthy volunteers". Cephalalgia 25 (2): 139–147. doi:10.1111/j.1468-2982.2004.00830.x. PMID 15658951. 
  25. ^ Verheggen R, Bumann K, Kaumann AJ (2002). "BIBN4096BS is a potent competitive antagonist of the relaxant effects of alpha-CGRP on human temporal artery: comparison with CGRP(8-37)". Br J Pharmacol 136 (1): 120–126. doi:10.1038/sj.bjp.0704682. PMC 1762122. PMID 11976276. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1762122. 
  26. ^ Louis S (1981). "A bedside test for determining the sub-types of vascular headache". Headache 21 (3): 87–88. doi:10.1111/j.1526-4610.1981.hed2103087.x. PMID 7263221. 
  27. ^ Blau JN, Dexter SL (1981). "The site of pain origin during migraine attacks". Cephalalgia 1 (3): 143–147. doi:10.1046/j.1468-2982.1981.0103143.x. PMID 7346182. 
  28. ^ Drummond PD, Lance JW (1983). "Extracranial vascular changes and the source of pain in migraine headache". Ann Neurol 13 (1): 32–37. doi:10.1002/ana.410130108. PMID 6830162. 
  29. ^ Lipton SA (1986). "Prevention of classic migraine headache by digital massage of the superficial temporal arteries during visual aura". Ann Neurol 19 (5): 515–516. doi:10.1002/ana.410190521. PMID 3717913. 
  30. ^ Vijayan N (1993). "Head band for migraine headache relief". Headache 33 (1): 40–42. doi:10.1111/j.1526-4610.1993.hed3301040.x. PMID 8436498. 
  31. ^ a b Shevel E, Spierings EH (2004). "Role of the extracranial arteries in migraine headache: a review". Cranio 22 (2): 132–136. PMID 15134413. 
  32. ^ Goadsby PJ (2009). "The vascular theory of migraine--a great story wrecked by the facts". Brain 132 (Pt 1): 6–7. doi:10.1093/brain/awn321. PMID 19098031. 
  33. ^ Brennan KC, Charles A (2010). "An update on the blood vessels in migraine". Curr Opin Neurol 23 (3): 266–74. doi:10.1097/WCO.0b013e32833821c1. PMID 20216215. 
  34. ^ Goadsby PJ (2006). "Recent advances in the diagnosis and management of migraine". BMJ 332 (7532): 25–29. doi:10.1136/bmj.332.7532.25. PMC 1325129. PMID 16399733. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1325129. 
  35. ^ Goadsby PJ, Charbit AR, Andreou AP, Akerman S, Holland PR (2009). "Neurobiology of migraine". Neuroscience 161 (2): 327–41. doi:10.1016/j.neuroscience.2009.03.019. PMID 19303917. 
  36. ^ Goadsby PJ (2009). "Pathophysiology of migraine". Neurol Clin 27 (2): 335–360. doi:10.1016/j.ncl.2008.11.012. PMID 19289219. 
  37. ^ Shevel E (2009). "Middle meningeal artery dilatation in migraine". Headache 49 (10): 1541–3. doi:10.1111/j.1526-4610.2009.01495.x. PMID 19656222. 
  38. ^ Shevel E (2011). "The extracranial vascular theory of migraine: an artificial controversy". J Neural Transm. Jan 5: Epub ahead of print. doi:10.1007/s00702-010-0517-1. PMID 21207080. 
  39. ^ Shevel E (2007). "Vascular Surgery for Chronic Migraine". Therapy 4 (4): 451–456. doi:10.2217/14750708.4.4.451. 
  40. ^ Shevel E (2011). "The Extracranial Vascular Theory of Migraine – A Great Story Confirmed by the Facts". Headache 51 (3): 409–417. doi:10.1111/j.1526-4610.2011.01844.x. PMID 21352215. 
  41. ^ Shevel, Elliot (September 19, 2007). "The Role of the External Carotid Vasculature in Migraine". In Clarke, Laura B. Migraine Disorders Research Trends. New York, New York, USA: Nova Science Publishers. pp. 165–183. ISBN 9781600215537.  Preview the chapter at Google Book Search
  42. ^ Shevel E, Spierings E (2004). "Role of the Extracranial Arteries in Migraine Headache: a Review". Cranio:the Journal of Craniomandibular Practice 22 (1): 132–6. PMID 15134413. 
  43. ^ Wolff HG, Tunis MM, Goodell H. (1953). "Studies on headache: evidence of tissue damage and changes in pain sensitivity in subjects with vascular headaches of the migraine type.". Transactions of the Association of American Physicians 66 (4): 332–341. PMID 13091465. 
  44. ^ Pickering GW (1939). "Experimental Observations on Headache". British Medical Journal 1 (4087): 907–912. doi:10.1136/bmj.1.4087.907. PMC 2209487. PMID 13306341. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2209487. 
  45. ^ Tunis MM, Wolff HG. (1953). "Analysis of Arterial Pulse Waves in Patients with Vascular Headache of the Migraine Type". American Journal of Medical Science 224 (5): 121–123. PMID 12985578. 
  46. ^ Shevel E (2007). "Vascular Surgery for Chronic Migraine". Future Medicine 4 (4): 451–456. doi:10.2217/14750708.4.4.451. 
  47. ^ Al-Zahrawi, Abu al-Qasim (c. 1000). Al-Tasrif. 
  48. ^ Shi FY (1989). "[Morphological studies of extracranial arteries in patients with migraine]". Zhonghua Bing Li Xue Za Zhi(Chinese) 18 (4): 271–3. PMID 2636957. 
  49. ^ Hankemeier U (1985). "[Therapy of pulsating temporal headache. Resection of the superficial temporal artery.]". Fortschr Med (German) 103 (35): 822–4. PMID 4054803. 
  50. ^ Sacristán HD, Ramírez AB (@9 April). "Tratamiento Quirurgico de las Jaquecas.". Annales de la Real, X Sesion Cientifica (Spanish). 
  51. ^ Rapidis AD (1976). "The therapeutic result of excision of the superficial temporal artery in atypical migraine.". J Maxillofac Surg 4 (3): 182–8. doi:10.1016/S0301-0503(76)80029-X. PMID 1066419. 
  52. ^ Holland JT (1976). "Three cases of vascular headache treated by surgery". Proc Aust Assoc Neurol 13: 51–4. PMID 1029006. 
  53. ^ Florescu V, Florescu R (1975). "[Value of resection of the superficial temporal vasculo-nervous bundle in some cases of vascular headache.]". Rev Chir Oncol Radiol O R L Oftalmol Stomatol Otorinolaringol. (Romanian) 20 (2): 113–7. PMID 127294. 
  54. ^ Bouche J, Freche C, Chaix G, Dervaux JL. (1974). "[Surgery by cryotherapy of the superficial temporal artery in temporo-parietal neuralgia]". Ann Otolaryngol Chir Cervicofac. (French) 91 (1): 56–9. PMID 4603862. 
  55. ^ Cook N. (1973). "Cryosurgery of migraine.". Headache 12 (4): 143–50. doi:10.1111/j.1526-4610.1973.hed1204143.x. PMID 4682552. 
  56. ^ Cook N. (1978). "Cryosurgery of headache". Res Clin Stud Headache 5: 86–101. PMID 674810. 
  57. ^ Murillo CA (1968). "Resection of the temporal neurovascular bundle for control of migraine headache.". Headache 8 (3): 112–117. doi:10.1111/j.1526-4610.1968.hed0803112.x. PMID 5730120. 
  58. ^ Nadler SB. (1945). "Paroxysmal temporal headache". JAMA: 334–335. 
  59. ^ Shevel E. (2007). "Vascular Surgery for Chronic Migraine.". Therapy 4 (4): 451–456. doi:10.2217/14750708.4.4.451. 
  60. ^ Shevel E (2007). "Vascular Surgery for Chronic Migraine". Future Medicine 4 (4): 451–456. doi:10.2217/14750708.4.4.451. 
  61. ^ Vijayan N (1993). "Head band for migraine headache relief". Headache 33 (1): 40–42. doi:10.1111/j.1526-4610.1993.hed3301040.x. PMID 8436498. 
  62. ^ Shevel E (2011). "The Extracranial Vascular Theory of Migraine – A Great Story Confirmed by the Facts". Headache 51 (3): 409–417. doi:10.1111/j.1526-4610.2011.01844.x. PMID 21352215. 
  63. ^ Mosser, W.; Guyuron, B.; Janis, E.; Rohrich, J. (Feb 2004). "The Anatomy of the Greater Occipital Nerve: Implications for the Etiology of Migraine Headaches". Plastic and Reconstructive Surgery 113 (2): 693. doi:10.1097/01.PRS.0000101502.22727.5D. ISSN 0032-1052. PMID 14758238.  edit
  64. ^ a b c d Guyuron, B. K. (Jan 2005). "Comprehensive surgical treatment of migraine headaches". Plastic and reconstructive surgery 115 (1): 1–9. ISSN 0032-1052. PMID 15622223.  edit
  65. ^ Poggi, T.; Grizzell, E.; Helmer, D. (Jul 2008). "Confirmation of Surgical Decompression to Relieve Migraine Headaches". Plastic and Reconstructive Surgery 122 (1): 115. doi:10.1097/PRS.0b013e31817742da. ISSN 0032-1052. PMID 18594393.  edit
  66. ^ Guyuron, B. T. (Jun 2002). "Surgical treatment of migraine headaches". Plastic and reconstructive surgery 109 (7): 2183–2189. doi:10.1097/00006534-200206000-00001. ISSN 0032-1052. PMID 12045534.  edit
  67. ^ Totonchi, A.; Pashmini, N.; Guyuron, B. (Jan 2005). "The zygomaticotemporal branch of the trigeminal nerve: an anatomical study". Plastic and reconstructive surgery 115 (1): 273–277. ISSN 0032-1052. PMID 15622263.  edit
  68. ^ a b c d e f Schwedt, T. J. (2009). "The Migraine Association with Cardiac Anomalies, Cardiovascular Disease, and Stroke". Neurologic Clinics 27 (2): 513–523. doi:10.1016/j.ncl.2008.11.006. PMC 2696390. PMID 19289229. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2696390.  edit
  69. ^ a b Waters, Jen (31 Jul 2007). "Easing Migraines.; Drugs, surgery help some; heart defect role studied". Washington Times (Washington, D.C.): pp. B01. 
  70. ^ a b c d e f Post, M. C.; Luermans, J.; Plokker, H.; Budts, W. (Jan 2007). "Patent foramen ovale and migraine". Catheterization and Cardiovascular Interventions 69 (1): 9–9. doi:10.1002/ccd.20931. ISSN 1522-1946. PMID 17143907.  edit
  71. ^ a b Wilmshurst, T.; Pearson, J.; Nightingale, S.; Walsh, P.; Morrison, L. (Nov 2004). "Inheritance of persistent foramen ovale and atrial septal defects and the relation to familial migraine with aura". Heart (British Cardiac Society) 90 (11): 1315–1320. doi:10.1136/hrt.2003.025700. ISSN 1355-6037. PMC 1768524. PMID 15486131. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1768524.  edit
  72. ^ Diener, H. K. (Jun 2007). "Patent foramen ovale and migraine". Current pain and headache reports 11 (3): 236–240. doi:10.1007/s11916-007-0196-2. ISSN 1531-3433. PMID 17504652.  edit
  73. ^ Wilmshurst, P.; Nightingale, S. (Mar 2006). "The Role of Cardiac and Pulmonary Pathology in Migraine: A Hypothesis". Headache the Journal of Head and Face Pain 46 (3): 429. doi:10.1111/j.1526-4610.2006.00374.x. ISSN 0017-8748. PMID 16618259.  edit
  74. ^ Wilmshurst, P. N. (Feb 2001). "Relationship between migraine and cardiac and pulmonary right-to-left shunts". Clinical science (London, England : 1979) 100 (2): 215–220. doi:10.1042/CS20000231. ISSN 0143-5221. PMID 11171291.  edit
  75. ^ a b c d Yankovsky, A. E.; Kuritzky, A. (2003). "Transformation into Daily Migraine with Aura Following Transcutaneous Atrial Septal Defect Closure". Headache the Journal of Head and Face Pain 43 (5): 496–498. doi:10.1046/j.1526-4610.2003.03096.x.  edit
  76. ^ Schwerzmann, M. W. (Apr 2004). "Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks". Neurology 62 (8): 1399–1401. ISSN 0028-3878. PMID 15111681.  edit
  77. ^ "Against the Migraine". Science News (Society for Science & the Public) 167 (8): 119–120. 19 February 2005. doi:10.2307/4016110. ISSN 0036-8423. JSTOR 4016110.  edit
  78. ^ Schürks, M.; Diener, C. (Jan 2009). "Closure of patent foramen ovale in the prevention of migraine: not enough evidence in favor". Nature Clinical Practice Neurology 5 (1): 22. doi:10.1038/ncpneuro0971. ISSN 1745-834X. PMID 19048002.  edit
  79. ^ Sarens, T.; Herroelen, L.; Van Deyk, K.; Budts, W. (Jan 2009). "Patent foramen ovale closure and migraine: Are we following the wrong pathway?". Journal of Neurology 256 (1): 143. doi:10.1007/s00415-009-0126-9. ISSN 0340-5354. PMID 19172218.  edit
  80. ^ Bhindi, R.; Ormerod, O. (Apr 2008). "Rebound increase in migraines following PFO closure". Catheterization and Cardiovascular Interventions 71 (5): 719. doi:10.1002/ccd.21394. ISSN 1522-1946. PMID 18360874.  edit
  81. ^ Wilmshurst, T.; Nightingale, S.; Walsh, P.; Morrison, L. (Sep 2005). "Clopidogrel reduces migraine with aura after transcatheter closure of persistent foramen ovale and atrial septal defects". Heart 91 (9): 1173. doi:10.1136/hrt.2004.047746. ISSN 1355-6037. PMC 1769061. PMID 16103551. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1769061.  edit
  82. ^ Sharifi, M.; Dehghani, M.; Mehdipour, M.; Al-Bustami, O.; Emrani, F.; Burks, J. (Jun 2005). "Intense Migraines Secondary to Percutaneous Closure of Atrial Septal Defects". Journal of Interventional Cardiology 18 (3): 181. doi:10.1111/j.1540-8183.2005.04068.x. ISSN 0896-4327. PMID 15966922.  edit
  83. ^ Collins, Lois M. (October 3, 2007). "Utah company's new stent may help repair heart defects". Deseret News (Salt Lake City, Utah, USA): pp. E1. 
  84. ^ a b "Patent Foramen Ovale". Cleveland Clinic. Cleveland Clinic. August 2009. http://www.clevelandclinic.org/heartcenter/pub/guide/disease/congenital/pfo.htm. 
  85. ^ "CardioSEAL Technology/Approach". NMT Medical, Inc.. http://www.nmtmedical.com/technology.aspx?id=90. 
  86. ^ "AMPLATZER® PFO Occluder for Patent Foramen Ovale Closure". AGA Medical Corporation. Plymouth, Minnesota, USA. 2008. http://international.amplatzer.com/international_products/pfo_device/tabid/522/default.aspx. 
  87. ^ Black, Cherie (October 22, 2007). "Researchers Look to Herat for Migraine". Seattle Post-Intelligencer (Seattle, Washington, USA): pp. A1. 
  88. ^ Yalonsky Stat, Terry (October 28, 2007). "Clinical Trial in the Works; Probing a heart-migraine tie". Chicago Tribune: pp. 8. 
  89. ^ "Error: no |title= specified when using {{Cite web}}". clinicaltrials.gov. http://clinicaltrials.gov/ct2/show/NCT00267371?intr=%22PFO+Closure%22&rank=3. 
  90. ^ Matharu, S.; Bartsch, T.; Ward, N.; Frackowiak, S.; Weiner, R.; Goadsby, J. (Jan 2004). "Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study" (Free full text). Brain 127 (Pt 1): 220. doi:10.1093/brain/awh022. ISSN 0006-8950. PMID 14607792. http://brain.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=14607792.  edit
  91. ^ a b Schulte-Mattler, W. W. (May 1999). "Treatment of tension-type headache with botulinum toxin: a pilot study" (Free full text). European journal of medical research 4 (5): 183–186. ISSN 0949-2321. PMID 10336407. http://www.nlm.nih.gov/medlineplus/botox.html.  edit
  92. ^ a b c Samton, J.; Mauskop, A. (Mar 2006). "Treatment of headaches with botulinum toxin". Expert Review of Neurotherapeutics 6 (3): 313. doi:10.1586/14737175.6.3.313. ISSN 1473-7175. PMID 16533136.  edit
  93. ^ a b Blumenfeld, A.; Binder, W.; Silberstein, S.; Blitzer, A. (Sep 2003). "Procedures for administering botulinum toxin type a for migraine and tension-type headache". Headache 43 (8): 884–891. doi:10.1046/j.1526-4610.2003.03167.x. ISSN 0017-8748. PMID 12940810.  edit
  94. ^ a b c Cady, R.; Schreiber, C. (Jun 2008). "Botulinum Toxin Type a as Migraine Preventive Treatment in Patients Previously Failing Oral Prophylactic Treatment Due to Compliance Issues". Headache the Journal of Head and Face Pain 48 (6): 900. doi:10.1111/j.1526-4610.2007.00953.x. ISSN 0017-8748. PMID 18047501.  edit
  95. ^ a b c Schürks, M; Diener, Hc; Goadsby, P (Jan 2008). "Update on the prophylaxis of migraine". Current treatment options in neurology 10 (1): 20–9. doi:10.1007/s11940-008-0003-3. ISSN 1092-8480. PMID 18325296.  edit
  96. ^ a b c d Naumann, M.; So, Y.; Argoff, E.; Childers, K.; Dykstra, D.; Gronseth, S.; Jabbari, B.; Kaufmann, C. et al. (May 2008). "Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology 70 (19): 1707. doi:10.1212/01.wnl.0000311390.87642.d8. ISSN 0028-3878. PMID 18458231.  edit
  97. ^ a b c Ondo, W. G.; Vuong, K. D.; Derman, H. S. (Jan 2004). "Botulinum toxin a for chronic daily headache: a randomized, placebo-controlled, parallel design study". Cephalalgia : an international journal of headache 24 (1): 60–65. doi:10.1111/j.1468-2982.2004.00641.x. ISSN 0333-1024. PMID 14687015.  edit
  98. ^ a b c Dodick, W.; Mauskop, A.; Elkind, H.; Degryse, R.; Brin, F.; Silberstein, D.; Botox Cdh Study, P. (Apr 2005). "Botulinum Toxin Type a for the Prophylaxis of Chronic Daily Headache: Subgroup Analysis of Patients Not Receiving Other Prophylactic Medications: A Randomized Double-Blind, Placebo-Controlled Study". Headache the Journal of Head and Face Pain 45 (4): 315. doi:10.1111/j.1526-4610.2005.05068.x. ISSN 0017-8748. PMID 15836567.  edit
  99. ^ Mathew, T.; Frishberg, M.; Gawel, M.; Dimitrova, R.; Gibson, J.; Turkel, C.; Botox Cdh Study, P. (Apr 2005). "Botulinum Toxin Type A (BOTOXR) for the Prophylactic Treatment of Chronic Daily Headache: A Randomized, Double-Blind, Placebo-Controlled Trial". Headache the Journal of Head and Face Pain 45 (4): 293. doi:10.1111/j.1526-4610.2005.05066.x. ISSN 0017-8748. PMID 15836565.  edit
  100. ^ Silberstein, S. D.; Stark, S. R.; Lucas, S. M.; Christie, S. N.; DeGryse, R. E.; Turkel, C. C.; Bonta-039 Study Group (September 1, 2005). "Botulinum Toxin Type a for the Prophylactic Treatment of Chronic Daily Headache: A Randomized, Double-Blind, Placebo-Controlled Trial". Mayo Clinic Proceedings 80 (9): 1126–1137. doi:10.4065/80.9.1126. PMID 16178492. http://www.mayoclinicproceedings.com/content/80/9/1126.abstract.  edit

Additional References

Wikimedia Foundation. 2010.

Игры ⚽ Нужен реферат?

Look at other dictionaries:

  • Migraine — This article is about the disorder. For other uses, see Migraine (disambiguation). Migraine Classification and external resources The pain of a migraine headache can be debilitating. ICD 10 …   Wikipedia

  • Atrial septal defect — PFO redirects here. For the airport, see Paphos International Airport. Atrial septal defect Classification and external resources Heart of human embryo of about thirty five days ICD 10 …   Wikipedia

  • Migraines associated with PFO heart defect — PFO, or patent foramen ovale, is a heart valve in humans that usually closes off at or shortly after birth. The valve’s function is to let the circulating blood bypass the lungs, which the body doesn t rely on until a newborn starts breathing air …   Wikipedia

  • Botulinum toxin — Clinical data Pregnancy cat.  ? Legal status  ? (US) Rout …   Wikipedia

  • Sinusitis — Classification and external resources Left sided maxillar sinusitis marked by an arrow. Note the absence of the air transparency indicating the presence of fluid in contrast to the other side. ICD 10 …   Wikipedia

  • Ménière's disease — Classification and external resources Inner ear ICD 10 H …   Wikipedia

  • nervous system disease — Introduction       any of the diseases or disorders that affect the functioning of the human nervous system (nervous system, human). Everything that humans sense, consider, and effect and all the unlearned reflexes of the body depend on the… …   Universalium

  • therapeutics — /ther euh pyooh tiks/, n. (used with a sing. v.) the branch of medicine concerned with the remedial treatment of disease. [1665 75; see THERAPEUTIC, ICS] * * * Treatment and care to combat disease or alleviate pain or injury. Its tools include… …   Universalium

  • Epilepsy — Epileptic redirects here. For the graphic novel, see Epileptic (graphic novel). Epilepsia redirects here. For the journal, see Epilepsia (journal). Epilepsy Classification and external resources Generalized 3 Hz spike and wave discharges in EEG …   Wikipedia

  • Aspirin — Asprin redirects here. For the author, see Robert Asprin. Aspirin …   Wikipedia

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”