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: http://www.georgetownuniversityhospital.org/body.cfm?id=555836

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.