Surgery brings relief for chronic migraines for one patient

"Once I got a headache, it never went away. Having a headache for that long changes your personality," Meredith said tearfully. "You don't want to talk to anyone. You don't want to do anything."

All that changed when Meredith, 18, had migraine surgery this past summer at UT Southwestern Medical Center. Now the headaches are gone, thanks to a procedure called nerve decompression surgery that has been gaining popularity as an alternative therapy for chronic headache sufferers.

Migraine surgery involves first identifying the compressed nerves through a clinical history and exam or use of Botox and nerve blocks. Then, the pressure causing the migraines is relieved by severing tiny muscles and other tissues pressing on and irritating these headache-trigger nerves.

Meredith's surgeon, Dr. Bardia Amirlak, Assistant Professor of Plastic Surgery, has successfully performed more than 100 such procedures over the past two years at UT Southwestern and refined the surgery with his own method of using an endoscope to target smaller blood vessels.

"This surgery is an option for patients with chronic headaches, nerve-compression headaches, occipital neuralgia, new daily persistent headaches, episodic migraines, and chronic migraines," said Dr. Amirlak. "However, before considering surgery, all patients should first be evaluated by a neurologist and try medical management."

According to Dr. Amirlak, who currently performs two to three migraine surgeries a week, about 60 percent of his patients get complete relief. Of the remaining 40 percent, nearly 90 percent of those experience at least a 50 percent reduction in pain, he said.

"Patients are coming from all over the country as well as from other countries," he said. "Not all migraine sufferers are candidates. We must be careful selecting candidates for this type of surgery."

Dr. Amirlak said patients who have tried several medications without success often are candidates for this surgery, including teenagers.

"I would rather operate on a young patient to prevent lifelong pain and suffering than to wait many years after their school, work, and social life has suffered. Here at UT Southwestern we are trying to establish standard protocols for migraine surgery in children," he added.

A year ago, the unrelenting, pounding pressure that radiated throughout Meredith's body during migraine episodes made it impossible to leave her darkened bedroom, let alone attend school. The headaches started her junior year of high school.

Meredith found no lasting relief despite consultations with more than a dozen different types of specialists who checked for viruses, infections, and allergies; trying nearly 50 different kinds of medications; undergoing numerous Botox injections and nerve blocks; and enduring several week-long hospital stays that involved administrations of D.H.E. 45, a last-resort medication prescribed for migraines.

"I never thought I'd get better; I thought I was doomed to be in bed my whole life," she said.

Dr. Amirlak operated on Meredith in June 2013 to relieve migraines concentrated at the front of her head.

"He spent an hour talking to us. He seemed really passionate about helping people, and we felt we had a bond with him," Meredith said.

Shelly Messerli, Meredith's mom, agreed.

"Dr. Amirlak is like family to us. He's our hero," she said. "It's a life-saver, this surgery."

Meredith said that now she cannot imagine what her life would have been like without the surgery. The experience prompted her to pursue a health care degree in hopes of a career as a microbial pathogenesis researcher. Now a freshman at Oklahoma State University, she has joined a sorority and plays intramural soccer. The headaches are no longer a dominating factor in her life.

"I wouldn't be in college right now if not for Dr. Amirlak," Meredith said. "I can do everything I used to do before. I'm excited to be myself again."