Monday, March 7, 2011

I Wonder

Still in a migraine funk...and now I'm convinced that this is what I get for thinking things were turning around. sigh

It is likely going to be another week or two before we hear if my husband got this new job in St. Louis or not. In the meantime I thought I would blog about this Georgetown doc who has developed a procedure for those who respond to occipital nerve blocks.

In the blogs that I follow I've seen that several of you get nerve blocks with a range of effectiveness. I wanted to share an experience that I had with you all because there is a doc around here who is doing something different. But he is not the only one who is addressing the occipital nerve as a way of addressing chronic and persistent headaches. He is just doing it differently.

Dr. Ducic is a plastic surgeon and head of peripheral nerve surgery at Georgetown University Hospital. When I first moved to the DC area I had gone online looking for a headache clinic within a reasonable distance and came across this article:

I phoned his office and was able to get a referral for one of the neurologists in the area who could help me determine if I was qualified for the surgery. That's how I found my neuro. The requirements were simple: have tried but failed to respond to medical preventatives, been under the care of a neuro doc for at least 2 years, and responsive to the nerve block.

The idea here is that the migraine can be induced by neuralgia and the neuralgia can be addressed by these nerve decompression or nerve severings and muscle implantations. He does this procedure on the Occipital nerves and other nerves on the temples, above the eyes and behind the ears. I don't know about you, but I have terrible pressure points on these nerves that are much worse on migraine days so this really sounded good.

When I got the occipital nerve blocks I saw an immediate improvement - like magic. Unfortunately, they were very short lived. By the time I would get home from the doc's office the back of my head was numb and the pain was beginning to return. My neuro and Dr Ducic agreed that as long as I responded - no matter how short in duration - I was a good candidate for the surgery.

After 3 nerve blocks and a consultation with Dr Ducic I was scheduled for the outpatient occipital nerve decompression. I wanted him to go ahead and take care of all the nerves but was told that would be a really tough thing to recover from and insurance was not likely to cover doing it all at once. He made a horizontal incision about 2 1/2 inches in length in the area where the head and neck connect in the hair, which did not have to be shaved. He severed two minor occipital nerves that are close together in the center and implanted them in the surrounding muscle tissue to prevent them from causing pain down the road. Then he moved muscle tissue that surrounds the large occipital nerve branches bilaterally, closed the incision and loaded my head up with serious numbing medications. Serious numbing meds - I didn't feel any pain for about 6 days and when the pain arrived overnight I woke up and vomited for the first time in more than 17 years. The first two week, as with most surgeries, were the toughest and slowly over the course of about 4 or 5 months I was able to regain my strength and energy.

Dr. Ducic has had a tremendously high success rate with this procedure and those who don't find full relief from it but who still qualify can get the main occipital nerve severed or can have the other nerve procedures to address the other pain points. After I recovered I found that I don't have migraine pain in the back of my head the way I used to. But I still have just as much migraine pain. So it was successful and I can get the other procedures and was about to do so before my last visit at Mayo.

Understandably so, the Mayo docs were not confident in this procedure. It has not been part of a study and it is just this guy at Georgetown doing it. Mayo is notoriously conservative and this procedure was developed outside of their watchful eye. I get it. But I see so many studies, sponsored by pharmaceutical companies, that focus on medicines to help those living with chronic persistent migraines and not many focus on just eliminating the problem instead of creating lifetime customers. There is real value to medical research and peer review, but I can't believe that everything outside of that is quackery. I wasn't able to find any evidence that would call Dr Ducic or his procedure into question. And I'm glad that I had the procedure even though it didn't "cure" me.

I wrestle frequently with the idea of having or not having the other procedures. And now as we prepare to leave the DC metro area it looks like I won't have the chance to decide to have it done. Originally I was going to do it a year ago January but then I had this issue with my ovary and had to have it removed. That made 2 surgeries in 6 months and my body was pretty upset about it. Even after I had recovered from the OB surgery I just wasn't ready to do that again - not yet. But then this whole thing came up with my jaw and I decided to go to Mayo in the summer. By the time fall came around I was so sick of all of this. I no longer cared why I was having them I just needed them to stop and these nerve surgeries seemed like the best option. And then I was back in Rochester to look after my mom after her knee replacement. I was having all the trouble with my meds and ended up back at Mayo where Dr Garza told me I wasn't taking my meds correctly - AND here we are. I haven't had the surgeries and I will likely always wonder what if. But I've also learned that I have some other options and who knows, one might actually work.

I also wonder if my response to the nerve block had been longer lasting, if that would have indicated that the occipital nerve decompression would have been enough to take care of all my migraines. As I read about you ladies having nerve blocks and other occipital treatments I always think about Dr. Ducic and these procedures that he has developed. I wish there was some collaboration among those who are addressing these nerves. I wonder how they are similar and how they are different. I wonder if they are different ways of doing the same thing. I wonder if they are unrelated.

Yikes, my head is screaming and my temp is rising. I must stop now.


  1. I've read about the decompression's sounds similar to the RFL I had back in July, except I did not directly have the occipitals done...which I would have loved to have done, but my doc wouldn't do it.

    The procedure was, for the most part, ineffective are nerve blocks for me...but I keep going back hoping it will work just this once!

  2. I wonder how this relates to using botox in the same areas. I'm seriously considering it because my muscle tension and pressure points are bothering me all the time now and in all the areas you mentioned the procedure is done. I see my Neuro on Friday and am going to ask a lot of questions about muscle tension and anxiety.

  3. Interesting. I am not sure I could bring myself to get nerves severed in my head. That is a scary idea. But I will be going back to get a second round of botox/nerve block combination (done a week apart).

  4. I so wish I could wave a magic wand and cure all of my migraine suffering friends. What is the connection, why do they happen, and why can't they find a permanent cure??? There has to be an answer! I hope they find one for you soon. I'm wishing you the best of health, and more blogging about your recipes! Be well.

  5. Jessica, I'm sorry it hasn't been working for you - wouldn't it be nice it any of these "treatments" worked...

    Mindy, That's an interesting question about how it might relate to botox. I might pose that question to my Mayo doc.

    Assiya, I think it sounds more serious than it actually is. The nerves being addressed are just sensory nerves located not far from the surface and basically severing them (if done correct by an experienced nerve surgeon) will just cause a loss of sensation in the area thy cover, which the body can largely compensate for over time. The nerve block basically does the same thing only temporarily. Surgery is what scares me...I'm always terrified I'll be awake but paralyzed and unable to communicate the pain.

    Della, I'm doing food today for you :)

  6. Interesting procedure, however I have a friend who had a similar procedure done for other nerves and after three years her nerves grew back!! Reconnected!! I had no idea they could when severed. She had had RFA done on them, steroid blocks done on them, and cutting the nerves was the last final step and then they grew back together. Wonder if anyone with his procedure has had this happen.

  7. Della, all I've read says we have overactive nervous systems and my Neuro doc says it is genetic. It is considered a nervous system disorder. I understand your frustration! As I read more about brain function, it looks like drugs that can calm our overactive brains our the best option. Triggers don't cause migraines, they just bring them on. Our genetics do.

  8. Winny, Oh my! I'm surprised (to say the least) to hear that nerves can grow back - that alone makes me not want to have the procedure - not that it's an option anymore. Your friend must have been so discouraged when this happened. And in just 3!

    I am pretty certain this doc isn't collecting data from his patients that far out from the procedure. The very idea - it's so astonishing. Thank you for sharing that.

  9. This is really interesting! I've bookmarked it and will definitely look into it further. Thanks!