Is Surgery an Option for My Migraines?
Updated February 21, 2015.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Approximately 35 million American suffer from migraines, a debilitating neurological condition that can negatively impact one’s quality of life both at home and in the workplace. Traditionally, treatment of migraines focuses on behavioral interventions, such as trigger avoidance and pharmacological or drug treatments. While these measures work for some individuals, others are resistant to these conventional methods of care.
In other instances, patients may benefit from a preventive or abortive medication but the side effects outweigh their benefit. In these instances, one may consider a more aggressive treatment, such as migraine surgery.
Please note that migraine surgery is a newer treatment for migraines and typically involves relieving pressure on the nerves thought to be responsible for your head pain. It is a controversial procedure and is really an unproven method of migraine therapy at this time. More studies proving its efficacy need to be completed.
That being said, let us review the process one may undergo if choosing migraine surgery in the future.
Before Surgery
Before undergoing migraine surgery, patients are carefully screened to make sure that their diagnosis of migraine is correct. This assessment is typically done by a neurologist, using criteria proposed by the International Headache Society. In addition, patients are often asked questions about the impact their migraines have on their quality of life and level of disability, as surgery is a major undertaking and something that needs to be thoughtfully considered.
There are different types of migraine surgery, but recently the focus of surgery has been on trigger site release. In this type of surgery, nerves around the skull are decompressed or relieved of pressure. This may involve removing part of a muscle of the face, so that the nerve cannot penetrate it anymore. The skull is not broken and there is no surgery done on the brain.
Once patients are screened appropriately, they often, but not always, first undergo a botulinum toxin trial in which various trigger sites in the head are injected. Botulinum toxin, known by the trade name Botox, is a toxin produced by the bacteria Clostridium botulinum and works by blocking nerve connections, which decreases muscle activity. It was approved in October 2010 by the FDA for treatment of chronic migraine. In terms of its use for a surgical intervention, botulinum is used as a test to see if surgery would be a more successful, long-term solution. Typical trigger sites used for injection include:
• the forehead
• temples
• occipital region or back of the head
• Intranasal (trigger point inside the nose)
If the patient notes a significant improvement, then surgical management of that trigger site is considered. Please note that a trigger site injection is not always done prior to surgery. Your surgeon will determine whether this is a necessary test prior to undergoing your procedure.
Surgery
Depending on the trigger site, there are different surgical techniques used. The surgeries are quite complex but the basic idea involves decompressing the nerves thought to be responsible for the migraine. Sometimes this involves resecting or removing a muscle group of the face. For example, a patient with migraines that occur in one or both of their temples, may be treated by having the a branch of the trigeminal nerve torn away. The big picture here is that the actual surgery varies based on the nerve and/or muscle group thought to be the cause of someone’s head pain during a migraine.
After Surgery
After surgery, you will follow up with your doctor to evaluate your response rate. Some of you may notice a reduction in the frequency, duration, and/or intensity of your migraines. Some may even have elimination of their migraines. It is difficult to say at this point, as the long-term evidence of migraine surgery is limited. The outcomes of migraine surgery are reviewed in more detail in my article, "Does Migraine Surgery Work?"
Take Home Points
• Surgery is a big deal and something that must be carefully considered. Please note that surgery for migraines is still a novel and rather controversial procedure. It's efficacy remains unproven. A detailed discussion about the potential side effects of surgery and the expected outcome of the surgery needs to be reviewed thoroughly with your headache specialist and surgeon.
• Migraine surgery is individualized, meaning that it is not the same for everyone with migraines. Your surgeon will test your trigger sites first to see what type of surgery is best for you.
• Only future studies will tell us whether this is a viable option for migraineurs. Regardless, please seek out the guidance of a headache specialist if you are suffering from migraines that are not better with usual medications or treatments. There are lots of therapy options out there. Be proactive.
Sources
Headache Classification Subcomittee of the International Headache Sociey. The International Classification of Headache Disorders. 2nd ed. Cephalalgia. 2004;24:1-60.
Kung, TA, Guyuron B, Cederna PS. Migraine Surgery: a plastic surgery solution for refractory migraine headache. Plast Reconstr Surg. Jan 2011; 127(1):181-189.
Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007; 68(5):343-9.
Totonchi A, Pashmini N, Guyuron B. The zygomaticotemporal branch of the trigeminal nerve: an anatomical study. Plast Reconstr Surg. 2005; 115(1):273-7.
DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Approximately 35 million American suffer from migraines, a debilitating neurological condition that can negatively impact one’s quality of life both at home and in the workplace. Traditionally, treatment of migraines focuses on behavioral interventions, such as trigger avoidance and pharmacological or drug treatments. While these measures work for some individuals, others are resistant to these conventional methods of care.
In other instances, patients may benefit from a preventive or abortive medication but the side effects outweigh their benefit. In these instances, one may consider a more aggressive treatment, such as migraine surgery.
Please note that migraine surgery is a newer treatment for migraines and typically involves relieving pressure on the nerves thought to be responsible for your head pain. It is a controversial procedure and is really an unproven method of migraine therapy at this time. More studies proving its efficacy need to be completed.
That being said, let us review the process one may undergo if choosing migraine surgery in the future.
Before Surgery
Before undergoing migraine surgery, patients are carefully screened to make sure that their diagnosis of migraine is correct. This assessment is typically done by a neurologist, using criteria proposed by the International Headache Society. In addition, patients are often asked questions about the impact their migraines have on their quality of life and level of disability, as surgery is a major undertaking and something that needs to be thoughtfully considered.
There are different types of migraine surgery, but recently the focus of surgery has been on trigger site release. In this type of surgery, nerves around the skull are decompressed or relieved of pressure. This may involve removing part of a muscle of the face, so that the nerve cannot penetrate it anymore. The skull is not broken and there is no surgery done on the brain.
Once patients are screened appropriately, they often, but not always, first undergo a botulinum toxin trial in which various trigger sites in the head are injected. Botulinum toxin, known by the trade name Botox, is a toxin produced by the bacteria Clostridium botulinum and works by blocking nerve connections, which decreases muscle activity. It was approved in October 2010 by the FDA for treatment of chronic migraine. In terms of its use for a surgical intervention, botulinum is used as a test to see if surgery would be a more successful, long-term solution. Typical trigger sites used for injection include:
• the forehead
• temples
• occipital region or back of the head
• Intranasal (trigger point inside the nose)
If the patient notes a significant improvement, then surgical management of that trigger site is considered. Please note that a trigger site injection is not always done prior to surgery. Your surgeon will determine whether this is a necessary test prior to undergoing your procedure.
Surgery
Depending on the trigger site, there are different surgical techniques used. The surgeries are quite complex but the basic idea involves decompressing the nerves thought to be responsible for the migraine. Sometimes this involves resecting or removing a muscle group of the face. For example, a patient with migraines that occur in one or both of their temples, may be treated by having the a branch of the trigeminal nerve torn away. The big picture here is that the actual surgery varies based on the nerve and/or muscle group thought to be the cause of someone’s head pain during a migraine.
After Surgery
After surgery, you will follow up with your doctor to evaluate your response rate. Some of you may notice a reduction in the frequency, duration, and/or intensity of your migraines. Some may even have elimination of their migraines. It is difficult to say at this point, as the long-term evidence of migraine surgery is limited. The outcomes of migraine surgery are reviewed in more detail in my article, "Does Migraine Surgery Work?"
Take Home Points
• Surgery is a big deal and something that must be carefully considered. Please note that surgery for migraines is still a novel and rather controversial procedure. It's efficacy remains unproven. A detailed discussion about the potential side effects of surgery and the expected outcome of the surgery needs to be reviewed thoroughly with your headache specialist and surgeon.
• Migraine surgery is individualized, meaning that it is not the same for everyone with migraines. Your surgeon will test your trigger sites first to see what type of surgery is best for you.
• Only future studies will tell us whether this is a viable option for migraineurs. Regardless, please seek out the guidance of a headache specialist if you are suffering from migraines that are not better with usual medications or treatments. There are lots of therapy options out there. Be proactive.
Sources
Headache Classification Subcomittee of the International Headache Sociey. The International Classification of Headache Disorders. 2nd ed. Cephalalgia. 2004;24:1-60.
Kung, TA, Guyuron B, Cederna PS. Migraine Surgery: a plastic surgery solution for refractory migraine headache. Plast Reconstr Surg. Jan 2011; 127(1):181-189.
Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007; 68(5):343-9.
Totonchi A, Pashmini N, Guyuron B. The zygomaticotemporal branch of the trigeminal nerve: an anatomical study. Plast Reconstr Surg. 2005; 115(1):273-7.
DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.