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Monday, August 20, 2018

WMC Finds a Cure for One Newburgh Woman’s Debilitating Migraines

Posted By: Advancing Care

When debilitating migraines left a Newburgh woman desperate, the multidisciplinary team at Westchester Medical Center found a solution.

By Lisa Cesarano

For 50-year-old town of Newburgh resident Susan Canfield, powering through debilitating pain became the only alternative to “losing your whole life.”

“I’ve had regular migraines over the past few years, but they began to get progressively worse,” she says. “I would be in tears while driving home from work each day.”

Beyond the blinding pain, her migraines also brought a pervasive sense of dread, even when she was pain-free. “It was scary to go to anything like a wedding or a concert with loud music because I was afraid the noise would start the pounding in my head. I worried every day that the headaches would come back.” 

Still, Canfield, an administrative assistant for the Marlboro Central School District and the mother of five grown children, would “go to work and plow through.” While her previous neurologist prescribed several different medications, “nothing worked. They said there was nothing else they could do for me.”

Hope for a cure had all but dissolved. However, in 2017, she read an article, and then saw a television news segment about WMC Headache Specialists at Westchester Medical Center, the flagship of the Westchester Medical Center Health Network (WMCHealth). She immediately scheduled a consultation.

Led by renowned authorities across numerous fields of medicine, WMC Headache Specialists is the New York-metropolitan area’s first integrated academic multidisciplinary center focused on the care and surgical cure of headaches.

“WMC Headache Specialists is unique in that we combine traditional and state-of-the-art treatments for migraines,” says Program Director Kaveh Alizadeh, MD, Chief of Plastic and Reconstructive Surgery at Westchester Medical Center. “Our approach combines internal medicine, neurology, pain management and surgery.”

According to Gary Rogg, MD, internal medicine physician at Westchester Medical Center, “The team meets once a month, discusses cases and comes up with a definitive plan. Most headache centers have neurologists and maybe pain-management experts. The advantage here is a truly comprehensive approach with intent on a cure, not just treatment, to get to the core reason for the headache and restore a person’s quality of life.”

To complement the medical staff’s expertise, a psychologist also meets with the team monthly to review the psychological aspects of each patient’s care.

The first stop in Canfield’s journey toward a cure was to search for clues potentially overlooked by previous physicians.

“When you see a new patient, it’s important to distinguish between a primary and a secondary headache,” says neurologist Jin Li, MD, Chief of Neuromuscular Medicine at Westchester Medical Center. Along with Dr. Rogg, Dr. Li re-established Canfield’s diagnosis and set her on a path toward definitive recovery.

“A secondary headache would include the headaches from tumor, stroke or infection,” she says. “After those are ruled out, via MRI and lab work, and sometimes even a spinal tap, you can then focus on primary headache syndromes, such as migraine or occipital neuralgia,” a condition in which nerves from the spinal cord to the scalp are inflamed or injured.

Extensive testing revealed that Canfield had undiagnosed degenerative disk disease, as well as history of a head trauma following a serious fall. “Based on these factors, we diagnosed her with occipital nerve neuralgia and referred her for pain management,” Dr. Li says.

“The first thing that I do is confirm the diagnosis,” says Nitin Sekhri, MD, Director of Pain Management at Westchester Medical Center. He describes his role as the “bridge between medical management and surgical intervention.” The diagnosis of occipital neuralgia was confirmed when Dr. Sekhri administered a lesser occipital nerve block, medication that eliminated the pain. “The relief lasted for about six weeks,” he says.

(From left) Husband Jerry, Susan, son-in-law Brendan, baby Declan, daughter Danielle, son Garrett, daughter Rachel and son Brandon.

Building on this success, Dr. Sekhri then suggested a procedure called cryoablation, in which the distressed nerve is frozen and temporarily “stunned.” While Canfield could have managed her condition effectively with regular cryoablation procedures, Dr. Sekhri felt a definitive cure was possible via a “surgical strike.”

Canfield was deemed an ideal candidate for surgical intervention, yet she was still a bit nervous. “But I decided that either I would have the surgery or live with these headaches forever,” she says.

After consulting with Dr. Alizadeh, Canfield underwent surgery in March. Small incisions in the back of the head freed constricted nerve endings that were causing pain.

“The procedure was pioneered by a plastic surgeon because they have a deep understanding of nerves, muscles and blood vessels,” explains Dr. Alizadeh. “It’s a simple procedure that results in significant improvement for 90 percent of patients. Sixty percent of patients are completely cured,” he notes.

Happily, Canfield is one of them. “I haven’t had one headache since,” she says, nearly six months later. “The surgery was the best thing I ever did.”

Dr. Alizadeh echoes Canfield’s enthusiasm about the procedure. “This is extremely gratifying work. Our patients always say they wish they had done this surgery sooner. One patient told me it was like living in black-and-white and then seeing in color for the first time. They can restart relationships with their spouses and children. They used to live in anticipation of each headache. Their entire lives were planned around headaches — it’s like waiting for an earthquake.”

While a cure cannot be guaranteed for each patient, says Dr. Sekhri, “Susan is a very good example of the success offered by our multidisciplinary team.”

Canfield’s experience with WMC Headache Specialists has opened her life to new possibilities. “The entire team has been wonderful,” she raves. “They’ve been absolutely amazing, incredible. They make it seem like you’re the only person who exists any time you call or have a question. I could not have asked for a better team.”

To make an appointment, call 914.909.6880 or visit westchestermedicalcenter.com/wmcheadachespecialists.

Photos by John Halpern