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Frequently asked questions about The Headache Clinic.


  • What is the long term prognosis if the treatment is successful?
  • There is migraine in my family – will that affect my chances of having successful treatment?
  • What are the possible side-effects and complications to the surgery?
  • How long do we need to stay?
  • Do you treat cluster headaches?
  • What is the waiting time to get an appointment?
  • Can you treat hormonal headaches?
  • Where will I stay while in Johannesburg?
  • Do you treat sinus headaches?
  • Why are your techniques not used in other countries?
  • Is there a risk of blood clots in the brain?
  • Where can I find out more about the arterial surgery?
  • Will having Botox injections before I come to South Africa affect your treatment?
  • What is the cost of treatment?
  • Why is the treatment sometimes unsuccessful?
  • Would it be possible for you to guide my doctor to perform this procedure?
  • What is the percentage success rate with your treatment? How successful is the treatment?
  • Is it not dangerous to permanently close arteries?
  • Is it not dangerous to permanently close arteries?
  • How do you know if I have muscular pain?
  • Is there any medication I should take before coming to South Africa?
  • How do you know whether I have arterial pain?
  • Can I contact previous patients?
  • Is the clinic in a safe area?
  • What post-operative medication will I be on?
  • Can any tests be done before coming to South Africa?
  • Should I continue my medication before coming for the surgery?
  • How long is the procedure?
  • Will I be staying in hospital?
What is the long term prognosis if the treatment is successful?

In successfully treated patients, the long term prognosis is excellent. It must be borne in mind though that it is always possible at any time after treatment that new pain centres emerge, and that further treatment becomes necessary.

There is migraine in my family – will that affect my chances of having successful treatment?

Although there is often a hereditary link in migraine, this does not make any difference to our ability to diagnose where the pain comes from and to administer the appropriate treatment.

What are the possible side-effects and complications to the surgery?

Possible post-surgical complications (These complications are rare but possible)

Short-term:

  • Post-operative wound pain and/or swelling.
  • Wound infection.
  • Post-operative nausea.
  • Blurred vision.
  • Loss of skin sensation.
  • Drooping eyebrow.
  • Difficulty in opening mouth, jaw pain, difficulty in chewing.
  • Temporary loss of hair in eyebrow.
  • Light-headedness.
  • Nerve/Scalp sensitivity

Long-term:

  • Sensitive scars.
  • Loss of skin sensation.
  • Scar keloid formation in susceptible individuals.
  • Treatment failure – patient’s condition unchanged.
How long do we need to stay?

It is of utmost importance that you spend as much time as possible with us. Because of the complex nature of the human body, and the many factors that may influence the outcome of treatment, the more time we have with patients, the better the chances of achieving a significant reduction in pain. After the initial treatment has been completed, new pain centres may come to light that need further interventions.

We advise patients to buy an open return ticket if possible, to allow for the greatest flexibility. Four weeks is the barest minimum. In the best cases we can achieve success in a matter of a few days. In the worst case it took us 52 days to achieve permanent success.

Do you treat cluster headaches?

We have had success with many cluster headache patients. Here are some post-treatment interviews with successfully treated cluster sufferers.

First Patient

Second Patient

Third Patient

Fourth Patient

Fifth Patient

What is the waiting time to get an appointment?

This is largely dependent upon the work load, which changes from time to time.

We do our best to accommodate patients coming from far, so please contact us on email address with your preferred dates, and we will confirm whether these dates are available.

Can you treat hormonal headaches?

Yes, we can treat hormonal headaches and are often successful.

There is a great deal of confusion though regarding hormone-related headaches. Most women with hormone-related headaches have regular cycles, which it means that their hormone levels are normal, even though they get headaches related to their hormone fluctuations during the cycle.

Headaches related to changes in hormone levels usually indicate that the body is responding in an abnormal way to the normal hormone fluctuations that occur during the menstrual cycle or at menarche (change of life). The only way to deal with the problem is to diagnose why your body is reacting abnormally to the normal changes in hormone levels. It is important to remember that the change in hormone levels is only a trigger, not the underlying cause of the pain.

Where will I stay while in Johannesburg?

The Headache Clinic staff will provide you with a list of suitable vetted accommodation venues in secure areas to suit your budget.

Do you treat sinus headaches?

Although the sinuses can play a part in the headache process, it is not nearly as common as people think. Research from headache clinics throughout the world shows that “sinus headache” is the most common misdiagnosis.

Just because the pain is in the area of the sinuses, or because the patient has a post-nasal drip or blocked nose when the headache strikes, doesn’t mean that the sinuses are responsible.

In fact what often happens is that when the underlying cause of the headache is treated, the sinus problems often clear up. If you have been diagnosed with sinus headache, then the statistics indicate that this is most probably a misdiagnosis.

Why are your techniques not used in other countries?

The research division of the Headache Clinic is The Migraine Research Institute (MRI). MRI’s breakthrough diagnostic and treatment procedures have been developed in house and are not available anywhere else in the world.

Because of the complex nature of head pain, the diagnosis is very complex, and takes a great deal of specialized knowledge. This body of knowledge has taken over 20 years to develop, and transferring this knowledge is a formidable task.

Is there a risk of blood clots in the brain?

The blood vessels to the brain are not involved, so the surgery does not involve the danger of blood clots to the brain at all.

Where can I find out more about the arterial surgery?

The arteries that cause the pain in migraine are the superficial arteries of the scalp – these are the terminal branches of the EXTERNAL carotid artery, (they have no connection with the brain, hence the safety of the procedure), and also sometimes the MAXILLARY artery which is behind the upper jaw.

Because the responsible arteries are not in the brain, but outside the skull, the surgery is safe. There is an abundant blood supply to the affected areas, so closing the few vessels that cause the pain does not cause problems.

Published papers on the surgery:

Vascular surgery for chronic migraine. Therapy 2007; 4: 451-456.

A New Minimally Invasive Technique for Cauterizing the Maxillary Artery and its Application in the Treatment of Cluster Headache.

Arterial surgery for sporadic hemiplegic migraine: preliminary results British Journal of Oral and Maxillofacial Surgery 52 (2014) 405–408

Will having Botox injections before I come to South Africa affect your treatment?

It may well obscure your symptoms and interfere with treatment. If Botox is necessary we will administer it.

That being said if you have had Botox and it has not worked then that in itself is an indication of the where the pain is, or rather isn’t coming from, and it may be helpful to us in the making of an accurate diagnosis. In order to make a decision please contact us for more insight here.

What is the cost of treatment?

The cost of treatment is dependent upon the diagnosis. To supply your medical data via our online form please follow this link.

Once we have this information we will be in a better position to give you cost estimates. Only once we have established an accurate diagnosis can we draw up an appropriate treatment plan and do the costing.

Why is the treatment sometimes unsuccessful?

The human head and neck areas are incredibly complex structures, and in spite of us having accumulated a great deal of knowledge and expertise, there is still much to learn. We keep striving to increase our knowledge base, but unfortunately there will always be treatment failures.

The single most important factor in reducing the failure rate however is time. The longer we have access to patients, the lower the failure rate.

Would it be possible for you to guide my doctor to perform this procedure?

The techniques we use are exceedingly complex, and it would require lengthy and intensive training to acquire the necessary knowledge.

What is the percentage success rate with your treatment? How successful is the treatment?

If everyone with migraine (or cluster, or tension headache) had exactly the same source of pain, giving a percentage would be an easy matter. Each patient however is unique, and has their own “migraine” map, which makes an accurate statistical analysis impossible. What we can say with confidence however, is that our successes are significantly more than our failures. Go to YouTube and type in “Dr Shevel Migraine Treatment Success”.

Is it not dangerous to permanently close arteries?

The blood supply to the scalp and other areas affected by the surgery is so extensive that closing the few arteries that are responsible for the pain has a minimal effect on the blood supply.

The body has a large excess capacity. It can be likened to having one tooth extracted and remaining with 31 with which to function.

Is it not dangerous to permanently close arteries?

The blood supply to the scalp and other areas affected by the surgery is so extensive that closing the few arteries that are responsible for the pain has a minimal effect on the blood supply.

The body has a large excess capacity. It can be likened to having one tooth extracted and remaining with 31 with which to function.

How do you know if I have muscular pain?

The history and description of the pain may indicate the possible presence of muscular pain, but the only way to be certain is to carry out diagnostic tests, including a clinical examination of the muscles. For that you would need to be here.

Is there any medication I should take before coming to South Africa?

Depending on the type of headache you have, we will advise you if you need medication for the plane trip. Alternatively take what you know will work.

How do you know whether I have arterial pain?

Follow this link and enter your information. This will give us a very good indication.

Can I contact previous patients?

Please go to YouTube and type in “Dr Shevel Migraine Treatment Success” to hear the personal stories of successfully treated patients or click on this link. There are many patients so it may take a little while to load.

If you would like to contact past patients personally, we have a list of people who have given their permission to be contacted by people contemplating the surgery.

Is the clinic in a safe area?

Johannesburg, like any other big city has its no-go areas. The clinic is not in one of these areas. In addition, we have 24/7 security at the clinic.

What post-operative medication will I be on?

Usually, the only post-operative medication that is necessary is for pain relief following the surgery. If an infection develops you may need antibiotics.

Can any tests be done before coming to South Africa?

Unfortunately, there are no facilities anywhere else that have the specialized knowledge of our diagnostic tests and procedures.

We charge a single global fee regardless of what is required for diagnosis so having one or two x-rays in your home country will not reduce the cost.

Should I continue my medication before coming for the surgery?

It would be ideal if you were not on medication at all, but neither do we want to submit you to increased pain in the build-up to your visit. If you are on medication that is safely helping your headaches, then please stay on it – if you feel however that your present medications are not benefiting you, then it would be preferable to wean yourself off them. If you are still on medication when you arrive, it should not prove a problem – the only medication that you should come off are any blood-thinning meds, including aspirin. This should be done in consultation with your medical practitioner.

With that in mind, certain medications have been found to have an important impact on our diagnosis and treatment, specifically those in the class of opiates (codeine, morphine, oxycondone and hydrocondone).

Regular high or low dosage use of these pain killers can, and will most likely, cause rebound headache pain, which can be confused with the actual pain we wish to diagnose and treat. Safe and structured weaning off of these medications should be done in consultation with a medical practioner or through a rehabilitation facility before treatment.

How long is the procedure?
The arterial surgery procedure takes approximately three hours, and is carried out under sedation. The “embolization” procedures where necessary usually takes no longer than an hour. After this procedure, the patient is kept under observation for a few hours before being allowed to go home. There are usually a number of follow up procedures of about an hour each. The number of follow-up procedures varies from patient to patient so please stay with us for as long as you can.
Will I be staying in hospital?

All the procedures are carried out on a day-patient basis, so it is not necessary to stay in hospital. We do have accommodation at the clinic though, so if you would like to take advantage of it please let us know.

*Treatment results may vary from person to person.

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Copyright by The Headache Clinic 2017. All rights reserved.

info@theheadacheclinic.net