Finding the Right Migraine Surgeon
Finding a migraine surgeon isn’t as easy as it might seem. Just do a Google search on “migraine surgery” and you’ll come across a variety of very different websites. Depending on your geographic area and what type of physicians or healthcare entities (hospital systems, clinics, etc) are trying to attract your attention, you’ll get all sorts of “answers” to your search.
Based on ongoing discussion in the Migraine.com community, we’ve invited Jason Hall, MD, to share his thoughts for patients interested to learn about nerve decompression surgery and Migraine. There are many evolving theories that apply to Migraine pathogenesis and treatment. The article below highlights opinions expressed by Dr. Hall, a plastic & craniofacial surgeon. Do not stop, start or change any treatment program without first discussing the benefits and risks with your health care professional.
My advice to any migraineur who is searching for information about migraine surgery or looking for a qualified physician is:
As we’ve discussed previously ("Curious About Migraine Surgery?" and "Choosing Surgical Nerve Decompression Candidates"), there is good science behind the different procedures available to treat migraine. However, the internet does not discriminate between who is offering a valid treatment and who is a scam artist that wants to take your money. Google tries, but isn’t perfect…far from it, judging by the stuff that comes up on the first few pages in my own searches.
Nerve decompression surgery for migraine is a “new” procedure, and was pioneered by a plastic surgeon based on a commonly performed cosmetic surgery (a brow lift). Consequently, the only surgeons who are trained to do this are plastic surgeons.
After their training, they become board-certified by the American Board of Plastic Surgeons (the ABPS) and become members of the American Society of Plastic Surgeons (the ASPS).
Board certification is tricky, and is used by lots of unqualified surgeons to “trick” patients – most notably in the cosmetic surgery field. I have written about the importance of board certification before if you are interested.
So, how do you separate the good from the bad, the scam artists from the legitimate surgeons? Here are a few tips:
- First, read with a prejudiced eye. Assume you are being scammed and let what you read convince you otherwise. If you read page after internet page and you feel that someone is trying to sell you something, then the odds are that you’re right. Listen to your intuition. Those of us who are honest recognize that there are many physicians and migraineurs alike who are skeptical that what we do in the operating room is legitimate, despite the science behind it. Speaking for that group, we are not trying to “sell” our services. Our websites and promotional material on the internet are for education and information. Sure, we all would like to help and will make it easy for us to be contacted, but it’s more important for us if you leave our sites better informed - whether you schedule an appointment or not.
- Research: The surgeon should be visible and searchable on the website. If you land on the page of a “migraine treatment center” or some other practice and don’t see the physician displayed prominently and clearly, keep moving. Medicine is a personal business – it is an intimate relationship between you and your doctor. If you have to make an appointment before you find out who you’ll be seeing, keep looking. Google me – you’ll see my website, complete with my picture, my bio, where (and in what specialties) I trained, and links to my Facebook page, Twitter page, and other social media outlets. If and when a patient comes to see me, they can know pretty much everything there is to know about my professional life. I have nothing to hide. Your surgeon or “treatment center” shouldn’t, either. You will find (or have found) that many “migraine treatment centers” with a high profile presence on the internet don’t have a doctor featured on the site at all. Run away - quickly. There are two places I know of in my area like this – one is run by a pain specialist who is pushing nerve stimulators as a “cure” for migraine (they can be effective, but like surgery, are not for all migraineurs) and the other is a clinic set up by a hand surgeon and one of his equipment salesmen. How either one of them have any experience with the complex anatomy of the head and neck or treating migraine, I don’t know. Perhaps they read an anatomy book? Maybe they watched some YouTube videos? Maybe they took a weekend course on migraine? I will freely admit that I went to Cleveland for Dr. Guyuron’s migraine surgery symposium after going and spending personal time with him in the OR. He is the "father" of nerve decompression surgery for migraine, and my experience was outstanding. However, before my trips to Cleveland I had already completed a full residency in plastic surgery where I had done numerous brow lifts and had good working knowledge of the anatomy, as well as a year-long fellowship in craniofacial surgery (plastic surgery of the head and neck). Those courses are intended to be for surgeons who want to “fine tune” their skills or adapt techniques they already use to treat migraines. They are not meant to give someone who has minimal knowledge of the anatomy or procedures the tools they need to perform safe and effective surgery. Had my time in Cleveland been my first exposure to the anatomy and surgeries for nerve decompression, I would be woefully unprepared to actually treat patients. However, that’s what some surgeons out there have done. Bottom line: research your surgeon’s background carefully before making an appointment, even if they come “recommended” by someone. Think for yourself and do your own research.
- Check for appropriate certification: I am aware of facial plastic surgeons who are not ABPS certified or ASPS members, but instead are certified by the American Board of Facial Plastic and Reconstructive Surgery – the ABFPRS. These are ENT (Ear, Nose and Throat) surgeons by training. Some of these surgeons have started doing migraine procedures and I would be comfortable recommending them as well, as they are well-versed in the complex anatomy involved, and have the skills to perform the surgery well. Ask about training. Nerve decompression of the head and neck is complex, and while it is similar to doing a “carpal tunnel surgery for your head” (the principles and physiology are similar) the anatomy isn’t. Getting operated on by someone who isn’t trained in complex head and neck anatomy is asking for a procedure that doesn’t work or ends up having complications. .
- Trust your gut. If someone gives you a bad feeling, or you feel like you’re being taken advantage of, walk away. Being nervous about surgery is OK – it’s totally normal. I tell all my patients – cosmetic, migraine, and reconstructive alike – that if you’re not nervous making a decision for surgery, something is wrong. However, there is a difference between being nervous considering surgery and getting that uneasy feeling like someone is trying to sell you something for their benefit and not yours. If you ever feel that way – that the surgery benefits the surgeon more than it benefits you – walk away. Chances are, your gut instincts are right.
We’ve covered a lot of ground here, and things can get pretty complicated pretty fast (especially the board certification alphabet soup). So I’ll summarize the things to watch out for in a few bullet points:
- If you feel like you’re being sold something, you probably are – move on.
- If the surgeon isn’t prominently displayed on the website – move on.
- If the surgeon isn’t certified by the ABPS (signified by ASPS membership) or the ABFPRS – move on.
- If you get a “bad vibe” about the surgeon or his office – move on.
I prefer, however, taking a positive attitude toward things. Migraine surgery can be a great treatment, and, done well, can be life changing. Here are a few good things to look for when researching a surgeon:
- Your surgeon’s website has lots of educational materials that don’t sound like a sales pitch.
- Your surgeon’s biography and picture are plainly displayed on the website.
- Your surgeon is board-certified by the ABPS or the ABFPRS.
- Your surgeon is honest about surgery being a treatment for migraine and not a “cure”
You, as a potential patient, have big decisions to make. I hope this post has made it a bit easier to filter through the internet noise and help you find someone that can hopefully give you some answers for your migraine pain.
Have you taken our Migraine In America Survey yet?