"Nothing seemed to work for my migraines.
Dr. Branch was my last resort."

RESERVE YOUR PRIVATE CONSULTATION WITH DR. BRANCH TODAY

Migraine Treatment

Dr. David Branch has been performing and teaching migraine surgery since 2002, when he founded the Northeast Migraine Surgery Center. He has treated innumerous migraine trigger sites on patients nationwide, and internationally from as far away as Dubai. The majority of his patients are now referred from neurologists, as well as from other reputable headache specialists.

Dr. Branch's first migraine patient was a chronic sufferer who had visited multiple headache centers around the country, including month-long admissions for intractable pain. She became immediately pain-free after her surgery in Bangor. The surgery is performed almost entirely in an outpatient setting. Gradually, migraine surgery has gained a foothold in mainstream care. Patients from Canada, particularly Nova Scotia, New Brunswick, and Quebec, can drive to Bangor for consultations and surgery. Dr. Branch's first patient went from chronic daily headaches to ONE headache over the first 9 years since the day of her surgery.

At Northeastern Interventional Pain and Migraine we specialize in the diagnosis and treatment of the source of your pain rather than tying you to a lifelong carousel of medications. We have found that with this approach, long term medications are less often needed and tend to work more effectively.

Come to Northeastern Interventional Pain and Migraine to finally get your headache pain under control.
Some patients may prefer a minimally invasive alternative to medications or injections for a more permanent solution.

  • Migraine Headache
  • Chronic Daily Headache
  • Cluster Headache
  • Menstrual Headache
  • Occipital Neuralgia
  • Sinus Headache
  • Trigeminal Headache
  • Tension Headache

How NEIPM's approach is different.

For decades the focus of migraine treatment has been on turning off the migraine pain once it has started. These "abortive" medications are to be taken early and at a high enough dose to stop the pain in its tracks. For some who respond only partially, this can be a prescription for a cycle of rebound headache. Also, for some, the headache can spread to different area of the head and neck, become more frequent or even become chronic unrelenting daily pain. This focus has involved medications that are taken to act centrally in the brain and circulated throughout the body. Most of the preventative medications have some classes of drugs that treat other conditions, such as high blood pressure, seizure disorders, depression, arthritis, and autoimmune disease to name a few.

What is hard to accept is the fact that most of these medications have no predetermined endpoint. Meaning, they are intended to be taken as long as the disease exists, possibly for life. This is despite the fact that most medications taken have only, at most, 5 to 10-year data about long-term side effects. Botox, or botulinum toxin, on the other hand has been used for nearly 50 years with one of the cleanest records in terms of side effects and adverse reactions.

Migraine surgery, likewise, and surgery in general has been tolerated for centuries, and the advancements in anesthesia over the last 50 years have made unexpected mortal complications exceedingly rare. In fact, Dr. Branch has yet to hear report of a significant complication or have a legal complaint brought forth by any migraine surgery patient (or any patient, for that matter), despite more than 1,600 migraine surgical procedures over the last 20 years. Dr. Branch, as the first surgeon on the East coast performing migraine surgery, has been host to many surgeons over the years seeking training in migraine surgery.

The Evolution of Migraine understanding and the Principles of Migraine Surgery

What we have known for years is that migraine disease is usually an inherited condition or predisposition. The headache is generated in the brain in the hind brain just above the occipital and trigeminal nerve nuclei (that receives information from the sensation nerves of the face, head and neck) which starts vessels to dilate, pain to be felt, and often a host of other symptoms.

What is new and exciting is the now widely accepted concept that the sensations coming through the occipital and trigeminal nerves can be the very thing that triggers the generator to begin the headache cascade. The most salient explanation is that a migraine headache patient's nerves have less insulating myelin and are more sensitive to normal stimulations, such as the pressure from a frown or a teeth clench or even a nearby blood vessel, causing normal pressure or pulsations to be felt as painful. As you might expect pain typically causes frowning, clenching and neck tightening, further compressing the nerves and starting a cycle of pain spawning more pain. If this process goes on long enough or there is some injury to one of these nerves, evolution from episodic to unrelenting daily headache will often occur.

The principles of migraine surgery involve reducing or eliminating background stimulation of these nerves mentioned above. This usually involves releasing a fibrous band (as in carpal tunnel surgery of the hand), reduction in the amount of muscle, and or removal of small arteries - any of which could be pressed against one or several sensory nerves of the head and neck. Some patients are stimulating the nerves that relay sensations within the nasal cavities with contact points that have long been known to stimulate a migraine headache. The contact points and vibrations are eliminated with conventional nasal airway surgery.

QUESTIONS ABOUT TREATMENT OPTIONS

What is migraine surgery/trigger point surgery/nerve decompression surgery for headaches?

Part of the evaluation that helps determine success involves the identification of peripheral migraine trigger zones that are responsible for the triggering of some, if not all of your migraine headaches. Peripheral triggers involve irritation, compression, vibratory stimulation, or simply errant signal interpretation through primarily branches of the trigeminal nerve (cranial nerve #5) and or the greater occipital nerve.
Nerve decompression is a migraine surgery that involves the decompression of several of the small terminal branches of the trigeminal and of the occipital nerves. When intranasal vibratory stimulation through the trigeminal nerve is felt to be a trigger, elimination of the vibration through opening of the nasal airway is performed.

Is Surgery right for me?

Generally, the surgery for migraines will be done as an outpatient procedure under sedation or general anesthesia. Patients with signs of localized nerve pain are the most likely to be offered surgery, while Botox testing or treatment may be the best first option for those with more globalized headaches.
Often the surgery involves decompressing the affected nerves by removal of muscle and sometimes vessels or even bone that is pressing on the nerves. The nerves are often covered with fatty (non-contracting) tissue.
When performed on the brow, the surgery is similar to a cosmetic brow lift.
In back of the neck, the greater occipital nerve is treated similarly through a hidden incision in the scalp.
Nasal airway surgery is a variation of the commonly performed procedure for a deviated septum resulting in breathing difficulty. Incisions are small and hidden.

How long does the procedure take?

The surgical procedure time can vary depending on the number of trigger sites (1 to 5, but usually 2-3). Each zone or trigger site procedure can take between 15 minutes and 2 hours.

What is the Success rate for Migraine Surgery?

The success rate for the treatment is 90%, with at least a 50% reduction of migraine symptoms. Approximately 35% of patients no longer experience headaches.
Dr. Branch's first patient has gone from chronic daily headaches to ONE headache over the span of 9 years since the day of her surgery.
How long does the surgery last?
Research has shown headache improvement/elimination to last at least 5 years. Dr. Branch's first patient has had 15 years of complete relief since her surgery in 2003.

Are there any side effects to any of these treatments?

Despite the sound of "migraine surgery", it is not brain or spine surgery. It is a field that focuses on shallow anatomy and sensory nerves, or employs familiar minimally invasive surgical techniques in the nasal airway. All surgery is serious and carries risk, but after over 1600 litigation-free migraine surgeries, complaints are rare and side effects usually involve some form of numbness or improvement in nasal breathing. The following is a list of possible side effects - Mild bruising or swelling lasting a few days up to 14 days, usually, Temporary (and rarely permanent) numbness in the forehead and scalp, Intense itching as sensation returns and nerves recover from surgery, Change in brow appearance and movement, Change in nasal breathing, usually improved, Migration of pain to a new or existing area. Talk to your doctor or physician for more information

Botox

What is Botox®?

Botox® is a small dose of Type A Botulinum Toxin that is injected to temporarily weaken the target muscles.

What are the chances that the injection for Botox® will help my migraine headaches?

Botox® has proven to be an extremely reliable prognosticator. Over 90% of the patients who respond favorably to the injection of Botox® benefit from migraine surgery. Studies have shown that 60-80% of the patients who have undergone injection with Botox®, with proper landmarks and techniques, experience elimination or significant improvement of their migraine headaches.

How does Botox® affect migraine headaches?

The hypothesis is that Botox® results in temporary weakening of the muscles that impinge on branches of the trigeminal and occipital nerves, as well as a possible "calming effect" on the nerves themselves. These nerve branches have been pinpointed as some of the trigger areas that cause migraine headaches. Some patients may choose to have off-label targeted botox testing or treatment with 30 to 80 units. The standard accepted injection protocol involves 31 injections and a wide dispersal of 155 units of botulinum toxin. This puts the medication into all implicated zones in the head and neck with the exception of headaches resulting from the stimulation of sensory nerves responsible for relaying sensations from within the nasal passages. This may be an effective long-term treatment option for those seeking ongoing injection therapy.

How long does Botox ® last?

The effect of a Botox® injection may last from 3 to 5 months in the muscles. However, migraine headaches may disappear only for 1 to 3 months.

Will my insurance cover Botox ® injections or the surgical procedure?

At this time most insurance companies will cover Botox testing or treatment, provided that conventional medical treatments, such as abortive and preventative medications, have been tried. Some insurance companies have specific requirements that must be met prior to Botox approval. Approval for surgery has been growing and appeals more uniformly successful. This has been improved particularly since the ASPS (American Society of Plastic Surgeons) released its official opinion on this new field citing 88 different supportive research papers, published over the last 20 year. See Opinion Paper here

Location

Northeastern Interventional Pain and Migraine
1945 Congress St
Building C
Portland, ME 04102
207-835-7079 Phone
207-947-1894 Fax

Bangor Plastic and Hand Surgery
55 Broadway
Bangor, ME 04401