Experts critical of Bilthoven private clinic's new headache surgery

A private clinic has opened in Bilthoven where patients with tension headaches can undergo surgery at their own expense. The founders of the Revive clinic claim an excellent success rate, but neurologists warn that there is insufficient scientific evidence to back the procedure, Trouw reports.

Two ENT specialists, Wilbert Boek and Hubert Faber, opened the Revive clinic. The procedure, which costs almost 5,000 euros, involves detaching a nerve in the forehead from the frown muscle and the periosteum. According to Boek, the clinic has already successfully operated on 20 people and 18 are now largely free of their headache complaints.

According to Boek, the procedure works especially well for people with tension-related headaches, though his clinic also invites migraine patients to see if they could benefit. “Migraine is a descriptive diagnosis,” he told the newspaper. “You don’t have a blood test or X-ray that can show it. We select very strictly before the operation: if you don’t respond fantastically to botox injections, you are not a candidate. The chance that the operation will be successful is, therefore, high.”

But experts are critical. “There is simply no scientific evidence that this works,” Leiden LUMC neurologist and headache expert Gisela Terwindt told the newspaper. “It’s fine if you have a new theory, but investigate it properly first. Now, desperate people are being offered something for a lot of money without any solid evidence.”

The fact that the Revive clinic uses botox as a selective tool to predict whether an operation will work is also worrying, Terwindt and her colleague Nadine Pelzer said. There is a proven treatment with botox for migraine patients, but that is a “completely different type of treatment,” Pelzer said. “A large amount is injected into the face and shoulders. Not a small amount in a few places.”

They think the success rate may be a placebo effect. “That effect can be very big,” Terwindt said. “But due to the lack of proper research, we don’t know that for sure.”

Hans Carpay, a neurologist and migraine expert affiliated with the Dutch Headache Association, agrees that the Bilthoven clinic's claims do not have a sufficient scientific basis. He thinks migraine patients would be better off following a proven effective course in regular care. “People quickly think that nothing can be done about their headaches. That is not the case. There are very good means to treat headache attacks, which are seriously underused. Less than 5,000 patients receive CGRP inhibitors, a preventive measure. There should be many more.”

Boek maintains that his clinic’s procedure has been extensively researched for 20 years and hopes that health insurance will eventually cover it. According to him, this is mainly a difference of opinion between neurologists and “cutters” like him. “They are purists,” Boek said to Trouw. “I understand them. But they should at least give this method a chance. We can help some people fantastically with it.”

Patient association Hoofpijnnet is following the developments critically, director Nelleke Cools told the newspaper. “People can become quite desperate from migraine complaints and are happy when they find something that could help. We are following developments with interest. That does not alter the fact that migraine is a serious brain disease, and not a stuck muscle or nerve.”