Migraine Surgery: Meredith Messerli

Oklahoma State University freshman, Meredith Messerli, 18, is in many ways, a typical college student. In addition to her pre-med studies, she is in a sorority, plays intramural soccer, stays up late, and eats junk food.

Meredith Messerli

But a year ago, Meredith thought college would be out of reach because of chronic, debilitating migraines that she began having when she was a junior in high school. The unrelenting, pounding pressure that radiated throughout her entire body during migraine episodes made it impossible for her to leave her darkened bedroom, let alone attend school.

Despite consultations with more than a dozen different types of specialists who checked for a slew of viruses, infections, and allergies; trying nearly 50 different kinds of medications; undergoing numerous Botox injections and nerve blocks; and enduring several week-long hospital stays that involved painful administrations of D.H.E. 45, a last-resort medication prescribed for migraines, Meredith found no lasting relief.

“Once I got a headache, it never went away. Having a headache for that long changes your personality; you don’t want to talk to anyone; you don’t want to do anything,” Meredith said tearfully.

A Good Morning America episode alerted Meredith and her family about the existence of migraine surgery, also called nerve decompression surgery.

Invented by a Cleveland plastic surgeon, migraine surgery involves identifying the compressed nerves and relieving the pressure that is causing the migraines. 

Meredith’s mom, Shelly, found a doctor in Houston who performs migraine surgery, which Meredith underwent for the pain in the back of her head in November 2012.

While the surgery relieved the migraine pain in that specific region, the migraine in the front of her head soon returned.

”I never thought I’d get better; I thought I was doomed to be in bed my whole life,” Meredith said.

But back home in Flower Mound, Texas, Meredith saw UT Southwestern’s Bardia Amirlak, M.D., on WFAA News talking about migraine surgery. She and her mom made an appointment to see him the following week.

Meredith with her mom, Shelly

“He spent an hour talking to us. He seemed really passionate about helping people, and we felt we had a bond with him,” Meredith said.

When people hear “migraine surgery,” they think it is brain surgery, but Dr. Amirlak wants people to know it’s not.

“We go nowhere near the layers of the brain; we don’t go very close to the spine. Some plastic surgeons are peripheral nerve surgeons and we stay in the superficial nerves of the forehead and the back of the neck,” he explained.

To those who say migraine surgery is an extreme measure, Dr. Amirlak stresses that it is neither extreme nor should be considered experimental anymore.

“We’ve done enough cases to show it’s not experimental,” he said. “It’s a good and valid option for patients with chronic headaches, nerve-compression headaches, occipital neuroglia, new daily persistent headaches, episodic migraines, and chronic migraines. In fact, about 80 percent of insurance companies approve the surgery in Texas. However, I would never operate on a patient who does not have a neurologist and who has not tried medical management that has failed.“

In June 2013, Meredith underwent her second migraine surgery for the pain in front of her head at Zale Lipshy University Hospital.

According to Dr. Amirlak, who performs two to three migraine surgeries a week, about 60 percent of his patients experience full elimination of migraine pain and nearly 90 percent experience a 50-percent reduction in pain.

“Patients are coming from both the east and west coasts as well as internationally,” he said. “Not all are candidates. We are very careful on selecting who may or may not be a candidate.”

The second procedure eliminated Meredith's migraines completely.

“I’m excited to be myself again. I can do everything I used to do before. I wouldn’t be in college right now if not for Dr. Amirlak,” she said.

“He’s like family to us,” Shelly added. “In fact, we’re having lunch with him the day after Thanksgiving.”

The Amirlak Method

Nerve decompression surgery was invented by plastic surgeon Bahman Guyuron, M.D., from Cleveland. After undergoing endoscopic forehead lifts for cosmetic reasons, which typically involve nerve decompression, his patients reported their migraines were better or completely gone.

Dr. Amirlak is a double board-certified plastic surgeon who trained under Dr. Guyuron for three years. He is doing extensive research in this area and has modified the original surgery.

The Amirlak Method, which is unique to UT Southwestern, is similar to the traditional method that decompresses the nerves in the forehead, temple, the back of the neck, and sometimes relies on sinus surgery, but it also addresses the smaller blood vessels. Dr. Amirlak uses an endoscope to visualize small areas of compression on the greater occipital nerve, and the method involves thorough decompression and ligation of the small branches of the occipital artery, which may be pressing against the occipital nerve in the back of the neck.