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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.*

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

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


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.

About the Treatment Centers and the “Migraine Procedure”

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 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 was invented and is performed by Dr. Ioannis Skaribas, a national and international expert in the field of neuromodulation. The actual procedure involves the application of bilateral occipital and supraorbital nerve stimulation. The application of peripheral nerve stimulation over the occipital and supraorbital nerves has been performed by many in the last 20 years. Many have claimed ownership of the concept; however, the invention of this procedure is credited to the interventional pain management medical 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.

About Dr. Skaribas

Dr. Skaribas is one of the leading authorities in the field of neuromodulation. He is a national and international expert that teaches and publishes 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. 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 actively performing neurostimulator implants since 2000 with more than a thousand cases performed to date.

Dr. Skaribas has been on faculty for both the Baylor College of Medicine and the University of Texas Medical Center in Houston and has been actively involved in the academic call for improvement in teaching residents and fellows. In the past 15 years, he has been the medical director for chronic pain management services over the largest anesthesia group in Houston. He is the medical director of Expert Pain Care, a practice dedicated to 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 not 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 the “Migraine Procedure” is performed on candidate patients.

Who is the right patient for the “Migraine Procedure”?

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, the usual injections, steroids, Botox, RFAs, and any other interventional therapies. This is a patient for whom the severity, chronicity, and frequency of migraine headaches has incapacitated them making everyday activities and enjoyment of life a struggle.

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

What is the “Migraine Procedure”?

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

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

What is the difference between the “Migraine”, “Reed” and “Omega” Procedures?

There is no difference!

These are all different names for the same procedure which is bilateral supraorbital and bilateral occipital nerve stimulation in the treatment of intractable severe migraine headaches.

What is a “Migraine Procedure” trial and why is it necessary

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 with the patient anesthetized and monitored in an operating room. This is an outpatient, same-day procedure. After the electrodes are placed and secured, they are connected to an external operating unit. They are then programmed to deliver treatment for migraines, and the patient goes home for a 5-7-day trial. During the trial, the patient is asked to keep a daily diary. The expectation is that there is going to be significant reduction in the severity and frequency of migraine headaches.

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

What is a permanent surgical implantation and how does it differ from the trial?

Permanent surgical implantation of the “Migraine Procedure” differs from a trial in the following ways. During the trial, electrodes are placed temporarily through needles. During the “Migraine Procedure”, permanent neurostimulating electrodes are implanted during a surgical procedure.

The surgical procedure is performed under general anesthesia. 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 in 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 that is safe and reversible. The components of the neurostimulating system are surgically placed superficially. There is nothing outside the body; everything is internally placed. After the surgical incisions have healed, the patient is able to resume everyday activities and function without any restrictions.

What are the steps to the “Migraine Procedure”?
  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 to the clinic after several days of trial 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 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.
Does the “Migraine Procedure” treat other types of headaches?

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

What is a primary headache?

A primary headache is a headache that is not associated with a secondary underlying cause. Examples of secondary causes can be 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’s classification of headache disorders (ICHD-3), 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
What is a secondary headache?
  1. Sinus headache
  2. Medication overuse headache
  3. Headache due to an infection like meningitis
  4. Posttraumatic headaches
  5. Spinal headaches
  6. Brain tumor or aneurysm headaches
  7. Cervicogenic headaches
Am I a candidate?

The typical patient that is a candidate for the “Migraine Procedure” is an adult suffering from severe intractable debilitating headaches that are nonresponsive to conservative, pharmacological, and other interventional treatments. For the typical patient, the severity and 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 a clinical consultation. Unlike other treatment centers and physicians, we do not conduct telephone interviews or conduct remote assessments. We believe that a 1-on-1 interaction with the physician as well as appropriate evaluation and clinical examination is of paramount importance for accurate diagnosis and treatment.



Expert Pain
11451 Katy Fwy, Suite 340
Memorial Area

Houston, TX 77079
Phone: 325-648-0871

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