Reply to pc guy and other negative comments about me on Clusterbusters
In health and medicine, results can never be guaranteed. This is true for treating the common cold, to delivering babies, or performing organ-transplants. No matter how effective the treatment, or how capable doctor or expert, there are always some patients that don’t respond, have complications, or in the most unfortunate scenarios, have negative effects.
The sole inspirational factor that keeps me passionate and fascinated about discovering more about how headache pain is generated, is the number of patients that respond well to my treatment methods and regain their quality of life. This number many times over, outweighs the number of patients that I have not been able to help.
When a procedure is effective, the fact that there may be unsuccessful cases is not reason enough to discard it.
For those Clusterbuster members that keep insisting that I do brain surgery to treat headache, I do not. I do not operate in the brain, and no procedure I have ever performed involves the brain in any way.
Some people have criticised me for posting on Clusterbusters, claiming that I am advertising. I didn’t start the thread, and when misinformation is put out about me or my work in a public domain, it is my right and duty to respond.
Regarding psilocybin and the use of magic mushrooms, I perceive no conflict between my approach and the use of magic mushrooms. Patients who are experimenting with mushrooms often contact me for my opinion. I always encourage them to only contact me should they not gain relief. Cluster sufferers who have adequate relief from psilocybin/ magic mushrooms or in fact any other medication most certainly are not candidates for my treatment. It is only indicated in those where other methods have not given relief from the cluster monster. No-one in their right mind would travel thousands of miles to undergo a surgical procedure if they were getting adequate relief from their medications.
I am a triple qualified medical practitioner with degrees in Dentistry, Maxillo-Facial and Oral Surgery and Medicine. Head and facial pain has always been my speciality. The fact that I am not a neurologist is the very reason that I have been able to approach headache treatment from a different perspective.
It is because I specialise in the structures of the face, head and neck, that I discovered that these structures outside the skull actually cause the pain in primary headache. Not the structures inside the skull or in the brain.
The fact that I do not treat the brain is the reason that neurologists have no interest in my work. The anatomical structures that I treat do not form part of their knowledge base.
I see an average 100 new patients a month and I have been treating headaches since 1992. That’s 25 years and many thousands of patients, with the vast majority of these patients being treated successfully, more so even in recent years as my knowledge has expanded. Were my techniques largely unsuccessful, there would be considerably more negative information on me on the web by now, rather than the hundreds of positive stories online.
Some people have commented that if my methods work they would be in the USA, but while the USA is a great country with many great people in it, not everything originates on American soil, and it would take the awareness of something new, and the will of those in the USA to learn it, for it to spread.
There was an important request from FramCire asking for the medical reasons for my work, and even though FramCire’s motivation is to discredit me (and I expect the same from everyone else on Clusterbusters), I welcome the opportunity to explain the rationale for my treatment of cluster.
The medical rationale for my treatment of cluster headache is as follows:
Primary headaches, including cluster headache, are exceedingly complex conditions and difficult to treat due to the great number of anatomical structures in the head and neck, which are all interlinked in some way. These structures include the brain and nervous system, arteries, muscles, tendons, sinuses, joints, and teeth. Many of these structures are innervated by the trigeminal nerve, which is widely accepted as the main conduit for primary headache pain, including cluster.
There is widespread agreement among headache specialists that many cluster symptoms occur due to the involvement of what is called the sphenopalatine ganglion (also known as the pterygopalatine Ganglion). One of the therapies being used at present to minimize the severity of cluster is sphenopalatine ganglion stimulation (Lainez, MA et al.Sphenopalatine ganglion stimulation for the treatment of cluster headache. Ther Adv Neurol Disord. 2014 May; 7(3): 162-168). The sphenopalatine ganglion is situated behind the upper jaw under the eye, and the maxillary artery is very close to it. When the maxillary artery dilates, it gives off pain producing neuropeptides – in patients where the dilated maxillary artery is very close to the sphenopalatine ganglion, the ganglion is without doubt affected.
Migraine can in no way be compared with cluster – but there is one vitally important similarity, and that is that they both respond to sumatriptan. Sumatriptan was developed as a vasoconstrictor to treat migraine, but as it transpired, it is far more efficacious in the treatment of cluster than it is in the treatment of migraine.
As the members of Clusterbusters are very aware, Imitrex (Imigran in some countries) injections are the most reliable and effective way of aborting cluster attacks for most cluster sufferers.
Remember, the only action of Imitrex is to constrict the painfully dilated extracranial terminal branches of the external carotid artery. It has no other action. This leads to the logic that if Imitrex works in cluster, then in cluster the painfully dilated EXTRACRANIAL TERMINAL BRANCHES OF THE EXTERNAL CAROTID ARTERY are INVOLVED IN THE PAIN.
The rationale and aim of my surgery is to achieve a permanent Imitrex effect. When the maxillary artery is permanently closed surgically, it no longer gives off pain-producing neuropeptides or impacts the collection of nerves of the sphenopalatine ganglion which generate the intense pain.
An illustration appeared on the cover of Cephalalgia in 2012, entitled “Location of maximum pain intensity in 209 patients with chronic and episodic cluster headache”. It is no coincidence that the precise area depicted is supplied by the maxillary artery. I am unable to post images here, but these can be referenced at http://www.theheadacheclinic.net/cluster-headache-treatment/
In my treatment of cluster, the most important element is permanent closure of the maxillary artery on the affected side. The major difference between the symptoms of cluster and migraine is because in cluster, not only are the scalp arteries involved, but the maxillary artery is also involved.
All the arteries that I close, including the maxillary, are done through small superficial incisions. These procedures are done in a day care facility and patients are discharged the same day.
It is important to note that these same arteries are closed by Neurosurgeons, Maxillo-Facial Surgeons, Plastic surgeons and ENT surgeons every day for a variety of other reasons. In spite of this there has never been a report of the blood supply being compromised as a result. A small number of patients have had temporary numbness of the skin or the cheek lining, most of whom recovered within a month or two. In the few cases where the numb patch persists, it is a relatively small price to pay for being pain free.
If it was only the maxillary artery that was responsible for cluster, the procedure would be done in a day and the patient would be able to fly home a few of days later. Frequently however, other anatomical structures are also involved in generating the pain. The most common are other terminal branches of the external carotid artery in the scalp, but the jaw and neck muscles and the three branches of the trigeminal nerve may also become painful.
Another factor is “central sensitivity” a term that has been given to an occurrence that I believe is correctly attributed to the brain itself becoming more sensitive to incoming impulses, and after time this heightened sensitivity also compounds the chronification of the headaches. Central sensitivity of the brain is one of the reasons why some patients don’t experience relief immediately after treatment, but report a gradual improvement over time as the central sensitivity subsides. An analogy for central sensitivity could be continuously scraping the skin on the same place so that any sensation on the inflamed spot is painful – yet as the skin heals, the sensations become less until no pain is felt at all – it is the same for the area of the brain that receives these pain signals.
If all these issues are not addressed, then the chances of success are much reduced. The varying roles of these interrelated structures determines the length of time and treatments needed for each patient – each patient has their own unique “pain map”.
I would like to state again, that the only patients I prescribe this surgery for are those who have not been helped sufficiently by the usual prescription medications used in cluster, or by oxygen, or by magic mushrooms, or by any other non-surgical treatment.
Here are the personal stories of some of my successful cluster patients http://www.theheadacheclinic.net/category/testimonials/video-testimonials/video-testimonials-cluster-headaches/ . None of them have to date had a recurrence of their clusters and none of them are taking any preventive medication: This most recent patient from Japan (subtitles are available on his video), nearly didn’t come for treatment after reading the comments on Clusterbusters.
If these people are all in remission, then it is an amazing coincidence that all their remissions started right after I operated on them, and that they are still cluster-free up to 4 years later.
For anyone interested in the complete story of what really happened with pc guy and other negative posts about me and my treatment methods on the web, they are available for full disclosure on The Headache Clinic website at http://www.theheadacheclinic.net/dr-shevel-addresses-negative-comments/
If I was unsuccessful with the majority of my patients, and was regularly faced with soul-destroying failures, I would never be able to continue treating cluster and other primary headache patients. On the contrary, it is the constant positive feedback from patients whose lives have been transformed that drives my passion and my commitment to the work I do.
