For the right patients, nerve decompression surgery eases the severe pain and disability of untreatable, worst-of-the-worst migraines and other headaches.

For 23 years after she was rear-ended in a car accident, Paula Stark Gorrell suffered through daily headaches and migraines so painful and disabling that she had to quit teaching. “I tried dozens of pills, muscle relaxants, yoga, massage therapy, acupuncture, Botox,” she recalls. “Nothing helped.”

Hundreds of people whose migraines hadn’t been helped by anything else have been helped by Dr. Austen.

Then, five years ago, she saw a television interview with William G. (Jay) Austen, Jr., MD, chief of Plastic and Reconstructive Surgery and chief of Burn Surgery at Massachusetts General Hospital. In it, he described surgery he had been performing that had dramatically helped patients with these worst-of-the-worst headaches.

A migraine is a throbbing headache with shooting pain. It is often accompanied by other symptoms like nausea, vomiting or sensitivity to light, smells and sound. It affects about 39 million people in the United States and more than 300 million around the world, mostly women. Although considered a brain disorder, migraines have various triggers that start outside the brain – sudden light, certain smells, the weather and irritated nerves.

Remarkable Results

The surgery Dr. Austen performs is based on the notion that sometimes nerves in the face and neck that control senses like vision and smell become irritated or compressed, triggering a migraine attack. By surgically removing tissue that presses on affected nerves — “nerve decompression” — he’s helped more than 80 percent of his patients find relief.

William Gerald (Jay) Austen Jr., MD
William Gerald (Jay) Austen, Jr., MD

Dr. Austen was one of the first plastic surgeons in the nation to perform this form of migraine surgery and is still one of the few performing the surgery and conducting research. Plastic surgeons discovered the involvement of compressed nerves in migraines serendipitously. Patients who had Botox or a brow lift to reduce wrinkles experienced headache relief as well. Those cosmetic procedures, they discovered, paralyzed or removed muscles that were pressing on nerves.

By using the same measurement tool that’s used for other chronic conditions like back or nerve pain, Dr. Austen and his colleagues found that pain and disability scores for those with previously untreatable migraines are “far worse than most patients with chronic pain,” he says.

“Although they are my most challenging patients, they are also the happiest after the surgery,” he adds. “The results have been remarkable.”

Research to Help More

Hundreds of people whose migraines hadn’t been helped by anything else have been helped by Dr. Austen. Though many with migraines find pain relief or prevention with existing medications, “most medications only work about 50 percent of the time and sometimes stop working after a while,” he says.

Through research, they want to learn how the surgery works physiologically to better predict those who might be helped by it.

“We’re trying to figure out through research how many more people may benefit from this surgery.”

Dr. Austen and his colleagues are creating a database of patient information accumulated from tests, tissue samples and follow-up surveys. They want to learn how the surgery works physiologically to better predict which patients might be helped by it.

Particularly exciting, he says, they are analyzing the genetic DNA and RNA in the tissue samples. “We want to look at the various inflammatory pathways involved to see what’s going on when patients get Botox or our surgery,” he says. “Understanding these pathways could even lead to better drugs for these patients.”

Philanthropy, notably from the Demarest Lloyd, Jr. Foundation, has enabled him to hire a research coordinator to start gathering and analyzing the data. “Philanthropy will continue to be critical for us to move the field forward,” Dr. Austen says. The field is so new that other sources of funding do not exist.

Life-Changing Surgery

About four years ago, Paula Stark Gorrell became one of Dr. Austen’s patients. At her first visit, he gave her a nerve block in the back of her head. “For the first time in 23 years, I had no headaches for three weeks,” she says. He told her that was a sign that his surgery could help.

This field is so new that sources of funding other than philanthropy do not exist.

The surgery was life changing. “I’m happy; my husband Mike and I are just plain happy,” she says. “I used to feel miserable all the time.”

She still gets occasional migraines, but not nearly as often or as bad as before. “I now go six weeks or longer without one,” she says. “That’s a miracle for me. Before I would have had 30 or 40 migraines during that time.”

She bikes, walks, goes to exercise class and fusses in the yard. “Dr. Austen gave me my life back,” she says.

For more information on how to support Dr. Austen’s research, please contact us.