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Some patients diagnosed with migraines fail to find relief through standard treatments such as medications or injections. As the only expert in Houston trained to perform this technique, Dr. Skaribas offers the “Migraine Procedure” (also known as the “Omega” or “Reed Procedure”), a minimally invasive surgical solution with excellent outcomes.*

The “Migraine Procedure” – Interrupting the Pain Signal 

A theory from the 1960s actually led to the development of cutting-edge treatments such as the “Migraine Procedure” (also known as the “Omega” or “Reed Procedure”). Mounting evidence over the years has supported the hypothesis that nerves are capable of carrying two signals at once. With the procedure, a neural message of pain on its way to the brain is overtaken and cancelled out by a competing message, a mild electric current from an implanted device.*

Similar to a pacemaker, the battery is small and unobtrusive. Also like a pacemaker, the battery is implanted under the skin, either on the chest or near the abdomen or buttocks. The device’s leads, insulated wires, run under the skin between the patient’s head and the battery—the receiver for the patient’s external remote.*

Test Run Essentials 

As with a pacemaker, a trial run is standard protocol to be sure that the “Migraine Procedure” will be an effective solution for a particular migraine patient. During the trial, temporary leads will be connected to an external generator usually worn on a belt. Then for the next several days, the patient needs to deliberately engage in whatever usually triggers his or her migraines such as coffee, bright lights or salty foods. This is the only way to determine how well the “Migraine Procedure” is going to work. A migraine trial takes some courage, obviously, but it’s critical at this juncture to log each stimulus and to what extent a headache was averted while utilizing the temporary device.*

Only after Dr. Skaribas reviews this log in detail and discusses the results carefully with a patient can he make a decision whether to proceed with permanent implantation.* 

The Good News

Happily, the vast majority of patients who test the “Migraine Procedure” are successful in using the device.* At this juncture, the battery pack can be permanently placed and connected to leads in whatever location most directly targets a patient’s head pain. While the battery is implanted about an inch below the skin, the leads will actually be just underneath the surface; even so, patients rarely report even being able to detect them.

 Although the procedure is not significantly invasive, Dr. Skaribas often recommends an overnight stay for observation. Full recovery takes several weeks, but non-strenuous activity can usually be resumed within seven days.* 

A Magic Button*

Many patients who used to fantasize about pushing a button and making their migraines disappear have that option with the “Migraine Procedure”.* The remote allows users to turn the system on or off, and to finesse the level of electrical stimulation to meet their particular needs and preferences. As always, Dr. Skaribas and his staff will be on hand to offer advice or instruction.

Dr. Skaribas placing an implant

Dr. Skaribas performing the “Migraine Procedure” for the treatment of migraine headaches.

Frequently Asked Questions

The “Migraine Procedure” offered by the Texas migraine treatment centers is a “holo-cephalic” cranial peripheral nerve stimulation procedure for relief of migraines and other primary intractable headaches.

The Texas migraine treatment centers are located in Houston, Texas.

Houston and the Texas Medical Center have always been in the epicenter of any ground-breaking medical therapies for a multitude of medical conditions and specifically in the treatment of migraines and other intractable cephalalgias.

The “Migraine Procedure” is a concept and term that has been invented and performed by Dr. Ioannis Skaribas, a national and international expert in the field of neuromodulation. The actual procedure involves the application of both bilateral occipital and supraorbital nerve stimulation. The application of nerve peripheral nerve stimulation over the occipital and supraorbital nerves has been performed by many in the last 20 years. Although many have claimed ownership of the concept, the intervention of this procedure belongs to the medical interventional pain management community at large.

The “Migraine Procedure” has over an 80% success rate as demonstrated by the clinical overall outcomes for more than 2000 patients that have received the implant at large.

Dr. Skaribas is the recognized authority in the treatment of intractable migraines and other primary headaches with the “Migraine Procedure” in the greater Houston area.

Dr. Skaribas one of the leading authorities in the field of neuromodulation. He is a national and international expert that teaches and probably cysts in the field of spinal cord and peripheral nerve neurostimulation. He has several publications in the field of headache treatment with implantable neurostimulating devices, and he is a member of the International and American neuromodulation societies.

Dr. Skaribas is double-board certified in anesthesiology and pain medicine by the American Board of Anesthesiology. He has successfully completed residencies in anesthesiology for a cumulative training of 80 years. In Houston, his internship and residency were completed at the Baylor College of Medicine in the world-renowned Texas Medical Center. After that, Dr. Skaribas completed a 1-year interventional pain management fellowship with the Baylor College of Medicine at the Methodist Hospital/Texas Medical center. Dr. Skaribas has been active neurostimulator implants there since 2000 with more than thousand cases performed to date.

Dr. Skaribas has been 5 QT for both the Baylor College of Medicine as well as the University of Texas Medical Center in Houston and has been actively involved in the academic call of improvement in teaching residents and fellows. In the past 15 years, he has been the medical director for the chronic pain management services over the largest anesthesia group in Houston. He is the medical director of “expert pain” practice dedicated in the comprehensive interventional treatment of intractable pain. He has been reviewed in the journal Neuromodulation, and he regularly contributes reviews to a publication related to the interventional and nerve stimulation treatment of severe migraines.

He has been performing the “Migraine Procedure” for the last 10 years.

Dr. Skaribas, unlike other physicians, does note outsource the procedures and performs every single “Migraine Procedure” himself. To this day, he has had no adverse outcomes and has seen remarkable success when this “Migraine Procedure” is performed on candidate patients.

The appropriate candidate for trial of the “Migraine Procedure” is a patient with severe intractable migraines that are resistant to any other therapies. The typical patient will be someone who has failed medication treatments, has failed the usual injections, steroids, Botox, RFA’s, and any other interventional therapies. This is a patient that the severity, chronicity, and frequency of the migraine headaches has incapacitated the patient making the everyday activities and enjoyment of life struggle.

The objective of the “Migraine Procedure” is successful therapy will be to restore the functional capacity of the patient and improve the symptomatology by alleviating the pain and improving the quality of life.

The “Migraine Procedure” is an implantable neurostimulating system, consisting of 4 neurostimulator electrodes entertain implantable pacemaker like battery-placed bilaterally underneath the skin to treat severe migraine headaches. The way physician best explains this device is that it is comparable to a pacemaker, 1 is similar device is tested and implanted for intractable pain from heart disease. The small electrodes are superficially placed.

The “Migraine Procedure” is reversible, superficial, very successful interventional therapy with a success rate over 80%. The rechargeable “battery” can last anywhere between 8-10 years and can be replaced swiftly without any electrode rearrangement.

There is no difference!

All these are different names for the same procedure, used to describe bilateral supraorbital and bilateral occipital nerve stimulation in the treatment of intractable severe migraine headaches.

A migraine treatment neurostimulation trial is necessary so that we can demonstrate the efficacy and good therapeutic results of the treatment modality and to provide justification for any further permanent implantation.

Temporary supraorbital and occipital electrodes are placed bilaterally through small needles and with the patient anesthetized and anterior monitoring in an operating room. This is an outpatient same day procedure. After the electrodes are placed and secured, these are connected to an external operating unit. They are then programmed to deliver treatment for the migraines and the patient goes home for usually 5-7-day trial. During the trial the patient is asked to keep a daily diary and the expectation is that there is going to be significant reduction of both the severity and frequency of the migraine headaches.

Although the insurance requirement is for more than 50% improvement of symptoms from a clinical standpoint, we always ask the patients and want to see more than 75% improvement of both the headaches as well as the overall improvement of the patient’s functional status and quality of life. The average patient usually starts seeing results after 24 hours and usually our results are quite remarkable with a significant improvement of the patient’s symptomatology.

Permanent surgical implantation of the “Migraine Procedure” defers from a trial because during the trial the electrodes are placed temporarily through needles versus the permanent implantation which is a surgical procedure involving placement of permanent neurostimulating electrodes.

It is a surgical procedure under general anesthesia where two supraorbital and two occipital neurostimulating electrodes are placed permanently under the skin into the appropriate nerve treating areas and are connected under the skin to an implantable neurostimulating controlling device called an IPG (implantable programmable generator). This is a rechargeable device which resembles a cardiac pacemaker and it is placed into the substance of the right buttock area. This is a small device which will be demonstrated to the patient during the initial office visit for educational purposes.

The “Migraine Procedure” is a permanent surgical migraine treatment option and is a safe and reversible procedure. The components of the neurostimulating system are placed superficially although surgically. Nothing is outside the body; everything is internally placed, and after the surgical incisions, the patient is able to resume everyday activities and function without any restrictions.

  1. Patient schedules an initial evaluation with Dr. Skaribas to determine if the patient is an appropriate candidate for the “Migraine Procedure”.
  2. Our care coordination team obtains pre-certification from the patient’s insurance.
  3. Patient is scheduled for neurostimulation trial.
  4. Patient returns after several days of trial into the clinic for an evaluation.
  5. One week after the initiation of the trial the temporary trial electrodes are removed. The overall efficacy of the procedure is evaluated and we determine if the patient is a candidate for a permanent surgical implantation with the “Migraine Procedure”.
  6. For patients that have been selected as appropriate candidates for surgical implantation after a successful trial, our care coordination team proceeds with insurance pre-certification for this permanent surgical procedure.
  7. Patient undergoes a permanent surgical implantation with the “Migraine Procedure” and is implanted with 2 supraorbital and 2 occipital neurostimulating electrodes and with the internally placed implantable rechargeable programmable neurostimulating generator.
  8. Days after permanent implantation with the “Migraine Procedure”, the patient returns to the clinic for the initial postoperative evaluation.

Yes, the “Migraine Procedure” successfully treats all primary holo-cephalic headaches sepsis migraines. Furthermore, components of this procedure can treat unilateral severe intractable headaches such as cluster headaches, and trigeminal neuralgias.

A primary headache is a headache not associated to a secondary underlying cause such as for example a head tumor, head aneurysm, sinusitis or any other pathology resulting in headaches.

A perfect example of primary headaches are migraine headaches.

According to the international headache Society classification ICHD-3, the primary headaches can be classified in the following categories:

  1. Migraines
  2. Tension type headache (TTH)
  3. Trigeminal autonomic cephalalgia’s (TACs)
  4. Other primary headache disorders
  1. Sinus headache
  2. Medication overuse headache
  3. Headache due to an infection since meningitis
  4. Posttraumatic headaches
  5. Spinal headaches
  6. Brain tumor or aneurysm headaches
  7. Cervicogenic headaches.

The typical patient that is a candidate for the “Migraine Procedure” is an adult suffering from severe intractable debilitating headaches that is nonresponsive to conservative, pharmacological, and other interventional treatments. For the typical patient, the severity of chronicity of the symptoms interfere with enjoyment of daily activities and the functional status of the patient.

To determine if you are candidate you will need to make an appointment with our clinic for Clinical consultation. Unlike other treatment centers and physicians, we do not contact telephone interviews or remote assessments because we believe that a 1-1 interaction with the physician as well as appropriate evaluation and clinical examination is of paramount importance in daily for accurate diagnosis and treatment.

*Results will vary by person and are based upon the patient, the surgery type and the compliance with the aftercare program. As with any medical procedure or surgery, there are specific risks and possible complications.