Treating ‘Untreatable’ Headaches

Neurosurgeon Giancarlo Barolat uses neurostimulation to treat patients suffering from debilitating and chronic migraine headaches that have not responded to other treatment modalities.

Often times, patients suffering from these types of chronic headaches have tried every possible drug and therapy available and found no relief. Sometimes they come to their appointment wearing noise-canceling headphones and dark sunglasses and request the lights be turned off, wary of any stimuli that might trigger a migraine headache. For these patients, neurostimulation can allow them to return to living a normal life. The nervous system is a complex electrical system and neurostimulation strategically sends impulses to various parts of it to correct abnormal electrical signals, thereby decreasing pain.

Prospective patients first undergo a test neuromodulation trial where Dr. Barolat implants electrodes either in their forehead or in the back of their head. Those electrodes are then connected to an implantable pulse generator (IPG), also called a neurostimulator. The patient uses a remote control to turn the device off and on and increase or decrease the pulse in order to control their headaches. When the electrodes are activated, the patient might feel a tingling sensation, which might replace the painful sensation. The trial test generally lasts anywhere from a week to a month. If the neurostimulation trial relieves the patient’s pain, they are scheduled for surgery. During surgery, Dr. Barolat implants electrodes and an IPG, which is around an inch-and-a-half square —under the skin, usually in the patient’s buttocks or chest. Learn more about the surgical treatment here.

The trial is effective for an estimated 8 out of 10 patients who then move ahead with surgery. One recent patient experienced a 99 percent reduction in her pain. Over the years, Dr. Barolat has evaluated and treated thousands of patients suffering from the most varied and difficult chronic pain conditions. Patients from around the country are referred to Dr. Barolat. During the initial consult, Dr. Barolat sits down with each patient and does an extensive evaluation of his or her condition. He outlines the most effective course of treatment and, if necessary, will refer patients to additional specialists with experience treating the patient’s condition. He believes that each patient he sees deserves the utmost respect and compassion.