Elliot Shevel

Elliot Shevel BDS, DipMFOS, MBBCh (b. ) is a South African Maxillo-Facial and Oral Surgeon, best known for his contribution to understanding of the underlying processes involved in the pain of migraine. He is, inter alia, a tireless campaigner to have the work of Harold Wolff, which many migraine researchers have sought to discredit, understood and accepted. Although Wolff and his co-workers showed conclusively in the 1940s that the terminal branches of the external carotid artery are a source of pain in migraine, his work has been forgotten, and most migraine researchers today are unaware of the importance of Wolff’s work. Shevel maintains that progress in the understanding of migraine pain has been materially [...] by this, and has published a number of papers on the subject.

Career

Shevel has practised as a Maxillo-Facial and Oral Surgeon in Johannesburg, South Africa, since 1973. In 1999 he was awarded an honorary fellowship by the International College of Craniomandibular Orthopedics, and he is a peer reviewer for "The European Journal of Neurology", the "Medical Science Monitor", the "International Journal of Clinical Practice", and "Headache", the official journal of the American Headache Society.

His first contribution to medical science was the development of an atraumatic method of removing impacted wisdom teeth, which significantly reduces the amount of post-operative swelling and pain.

Muscles and migraine pain

In 1992, he developed an intra-oral appliance (called the Posture Modifying Appliance or PMA) for the treatment of the myofascial pain dysfunction syndrome (MPDS). When some of his patients reported that wearing the PMA had reduced or eliminated their migraines, he realized that there must be a muscle tension component to the pain of migraine. This was confirmed in a literature search, which revealed that the presence of pericranial muscle tenderness in migraine had been extensively documented, and that there is focal pericranial (masticatory and cervical) muscle tenderness with associated referred symptoms that reproduce the headache pain. As the migraine headache increases in intensity, there is increasing tenderness of the pericranial muscles. The literature search also revealed that various intra-oral appliances designed to reduce muscle tension, are effective in the treatment of migraine. Shevel started restricting his practice to the treatment of migraine and tension-type headaches. The results of muscle tension treatment with the PMA for tension-type headache and for the muscle tension component of migraine are excellent, particularly as the medication with its side-effects is eliminated or reduced in successfully treated migraineurs. Although the treatment of muscle tension has been shown to be effective in some migraine sufferers, this form of treatment has not been recognized by the vast majority of migraine specialists, and muscle pain is not listed as a symptom of migraine in the official headache classification of the International Headache Society.

Arteries and migraine pain

In 1995, Shevel observed that in some migraine patients the frontal branch of the superficial temporal artery throbbed visibly during a migraine attack. Digital compression of this artery sometimes resulted in the pain being reduced or eliminated while the pressure was maintained. When the pressure was removed, the pain returned. As a Maxillo-Facial Surgeon, he knew that this vessel could be tied off without any untoward side effects. Encouraged by the results of the surgery, he decided to publish a description of the procedure. At that stage, Shevel was unaware of the work of Harold Wolff, but when he studied the published literature, he was astounded to find that the involvement of the extracranial terminal branches of the external carotid artery in migraine pain had been recognized and proven by Wolff as long ago as 1934. Wolff’s theory has since been confirmed many times.

Arterial surgery for migraine

Armed with this knowledge, he developed a protocol for the identification of the painful vessels, and their surgical cauterization. The results of surgical cauterization in selected patients were excellent, particularly as all the patients undergoing the surgery were suffering from ‘refractory migraine’ – migraine that had not responded to any other form of treatment.

A search of the literature brought to light a number of previously published published papers describing either ligation or cryotherapeutic ablation of the terminal branches of the external carotid artery for migraine and migraine-like headaches. The first mention in the literature of arterial migraine surgery was by Abu Quasim al Zahrawi, the personal physician to King Hassan of Spain (936-1013). Since then there have been numerous reports of this procedure from many countries, but they have been largely unnoticed or ignored by mainstream headache scientists. Painful dilatation of the extracranial terminal branches of the external carotid artery is not a diagnostic criterion for migraine in the International Headache Classification, and most headache specialists are unaware that is an important component of migraine pain. On the contrary, some have, notwithstanding the evidence, made a concerted attempt to discredit Wolff’s findings, even though no one has been able to provide evidence that disproves Wolff’s theory. Shevel has devoted himself to resuscitating Wolff’s ideas, and to this end has published a number of articles in peer-reviewed medical journals. and writes a constant stream of letters to the editors of the important headache journals.