The surgical treatment of migraineBMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7285.526/a (Published 03 March 2001) Cite this as: BMJ 2001;322:526
During the last five and twenty years I have never failed to treat successfully the most inveterate and severe cases of migraine by the introduction of an ordinary tape seton through the skin at the back of the neck.
My last case, and the one which has induced me to make this communication, is that of a lady who has never for the last six years escaped many weeks without “a brain storm” of such severity that she has been completely prostrated with violent headache and sickness for periods extending from twelve to twenty-four hours. Since the introduction of a seton some months ago she has not had a single attack.
As the use of the seton has gone out of fashion, and probably the younger members of the profession have never seen it used, I may perhaps be allowed to explain for their benefit the modus operandi more in detail. The skin at the back of the neck is grasped between the finger and thumb of the left hand, and behind the fingers a long-bladed scalpel is forced so as to transfix the skin. Before the knife is removed, a long probe provided with a suitable eye is passed through the wound, using the knife as a guide. The scalpel is then, withdrawn. A piece of ordinary household tape half an inch wide is then attached by a ligature to the eye of the probe and the probe pulled through the wound, bringing the tape with it.
Four inches of tape are left free at each side, and these are gently tied together to prevent the tape being accidentally withdrawn.
Instructions are given to the patient to move the tape from side to side each day. The interposing skin between the point of entrance of the seton and that of exit naturally varies with the thickness of the skin of the individual patient, and in some cases may only be an inch, whereas in others there may be a distance of 2 inches.
The operation, if performed with moderate dexterity, need only occupy half a minute, and nitrous oxide is all-sufficient as an anaesthetic.
The seton ought to be worn uninterruptedly for three months at least in the first instance, and should the symptoms recur a second seton ought to be introduced.