Bangor doctor pioneers rare migraine treatment
Photo/Tom Weber
Dr. David Branch, a surgeon in Bangor, is one of the few doctors in the world performing a rare migraine treatment
Dawn Lewis suffered from debilitating migraines for 15 years until she found Dr. David Branch, a plastic and hand surgeon in Bangor who is the only doctor in the country performing a rare surgery to cure extreme headaches. Migraine surgery now represents close to 20% of Branch's practice, and he expects it to grow more as word spreads of its success and his long involvement in it.
Branch is one of only a handful of doctors in the world to regularly perform a little-known migraine surgery procedure pioneered by Dr. Bahman Guyuron, a plastic surgery professor at Case Western Reserve University in Cleveland. The surgery involves removing of small bits of muscle from the forehead, temples and back of the head, reducing the pressure on those points suspected of triggering migraines.
Lewis, an employee at Cianbro in Pittsfield for 17 years, was recommended to Branch at the end of 2008 and had the surgery last May. She hasn't had a migraine since.
The procedure got a big public relations boost last year after a double-blind study by Guyuron and others was published in the journal Plastic and Reconstructive Surgery and reported in the national media. The study found that migraines were significantly reduced in more than 80% of patients who underwent surgery on one or more of the trigger sites, as opposed to more than 55% in the placebo-surgery group. More than half of the patients who had the genuine surgery reported that their headaches disappeared completely.
"That really put it the map," says Branch, who has been getting more referrals from physicians as a result of the national attention. "But people still think it's odd that there's only a handful of us doing it, and that one of us is in Bangor, Maine."
Despite recent attention, the procedure isn't new. Guyuron developed it more than a decade ago after some of his patients reported a reduction in migraines headaches after cosmetic Botox injections or surgical brow lifts. Guyuron discovered that Botox weakened the muscles that were connected to the nerve branches thought to trigger migraines, and decided to develop a surgical procedure that could resolve the migraines permanently.
Branch trained with Guyuron in Ohio and began performing the migraine surgery seven years ago at his practice in Bangor. He begins by injecting patients with Botox, which is used to locate and identify the common trigger sites in the brow, temples and neck. He then sees the patients in four to six weeks to evaluate the Botox effect and determine which trigger sites are most likely to respond to surgery in suitable candidates.
During outpatient surgery, done under sedation or general anesthesia, small, mostly hidden incisions are used to relieve the pressure of muscle on the nerves, which are then wrapped with fatty tissue. Of the 60% to 80% of patients who respond favorably to Botox, Branch says, 90% of them benefit from migraine surgery.
Lori Welch, Branch's migraine patient coordinator, says people from across Maine as well as 10 other states and two Canadian provinces have come to Bangor for treatment. There are more than a dozen patients now undergoing preliminary Botox testing, five more ready for surgery and eight others in consultation, including one woman from Saudi Arabia.
"My first patient was a completely different person after the surgery, and I've been hooked ever since," says Branch. "It's quite a remarkable thing to see a person transformed like that."
The biggest hurdle right now, however, is convincing insurance companies to pay for a procedure that involves the use of Botox, which is most commonly associated in the public mind with cosmetic enhancements. So far, none will pay for the Botox treatments, which can cost as much as $1,200, although some Maine insurers are agreeing to pay for at least part of the costs of the surgery itself.
"The trend is that they're starting to pay a portion of the surgery, operating room and anesthesia fees," Welch says. "It's not 100% yet, more like 60%, but they're coming around slowly."
For Lewis, having to come up with the money for Botox treatments -- her insurance company, Cigna, did finally agree to cover her surgery bills -- was a small price to pay for the relief she found after so many years of pain.
"In the last year I have had no migraines at all," says Lewis, who wondered for a month after the surgery whether her headaches would return to haunt her as before. "I just cannot put into words what this has done for me, how much better it is for me, my family, my job. My life was at a standstill, and now I've got my life back."
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