“I started my medical career in 1967 as a dentist and then specialised as a maxillo-facial surgeon in 1969 to treat conditions of the hard and soft tissue of the head, neck, face and jaws. I then qualified with medicine as my third medical degree in 1973.
My personal experience with migraine started in the early 90’s while practicing as a maxillo-facial surgeon. I designed a new intra-oral appliance (which I now call a PMA) to treat painful jaw muscles by helping to relax the jaw into its natural rest position. To my surprise, many of the patients that I treated for jaw muscle tension reported that their migraines improved or disappeared with the use of the PMA. I was surprised and fascinated by this result, so I started studying the migraine and headache literature and was amazed by what I found.
My extensive research uncovered long forgotten methods and buried medical accounts that are not widely known or referred to in headache literature. This information, combined with the number patients that reported relief from their headaches was so significant that I started The Headache Clinic in 1992. Little did I know at the time what a fascinating journey was beginning, and that my professional life would eventually become completely absorbed by this new and exciting voyage of discovery.
In 1995 I discovered that there is also an arterial component to migraine pain, involving the terminal branches of the external carotid artery. One day while we were wheeling a patient into theatre for an oral surgery procedure, she complained of a throbbing unilateral headache. As she was quite a thin individual, the throbbing frontal branch of her superficial temporal artery was clearly visible pulsing on her forehead. Out of curiosity I pushed the vessel with my forefinger to compress it and the pain disappeared. When I removed the pressure, the pain returned immediately.
It was clear that the pain was coming from the dilated throbbing artery. Now, as a Maxillo-Facial Surgeon, I knew that there would be absolutely no downside if I tied off the artery – there is a fantastic blood supply of hundreds of blood vessels in the scalp and these vessels are often damaged in trauma or during surgery with absolutely no ill-effects – so I asked the patient if she wanted me to tie off the vessel, and she readily agreed.
I followed her up for a few months and her headache did not recur, so I decided to publish what I believed was a world first. Fortunately I first searched the literature, and found a number of previous reports of arterial ablation for migraine – the unique procedure I had just performed.
The first written record of the involvement of the extracranial arteries in headache is attributed to Abu Qasim al-Zahrawi (936-1013AD), the renowned Moorish physician (known in the West as Abulcasis or Abucalsis), who treated headache by surgical ligation of the superficial temporal artery. A hundred years later, the prominent medieval Jewish physician, Moses Maimonides (1135–1204AD), stated that headaches in general can be alleviated by mild pressure to the head.
Ambroise Paré (1510-1590AD), regarded by many as the father of modern surgery, divided his own superficial temporal artery to relieve his migraine headaches. Remember – they had no anaesthetics– doctors were obviously made of very stern stuff in those days.
In the 17th century Thomas Willis, widely regarded as one of the founders of modern neurology, suggested that the source of pain in some headaches was distended blood vessels, providing the basis for the vascular theory of migraine.
But it goes even further back than that – the San people of the Kalahari Desert have been cutting their scalps to ligate painful vessels for the last 50,000 years. So, with all this evidence lined up against me, I reluctantly had to concede that I actually wasn’t the first.
Since then I have been on this fascinating journey of scientific discovery for the last twenty -five years, and I am still discovering more and more. This journey has only been possible, because I as a Maxillo-facial and Oral Surgeon have been able to approach migraine from an entirely new perspective to the traditional approach taken by neurologists.
My greatest dream is for other Maxillo-facial Surgeons to take an interest in my work, so that they can learn how to treat headache and migraine and help 1 BILLION people around the world who suffer terribly with this misunderstood, misdiagnosed, and mistreated condition.”
~ Dr Elliot Shevel