The Surgical Treatment of Migraine Headaches
Surgery for migraine headaches was first discovered by Cleveland plastic surgeon Bahman Guyuron, MD, who noticed that patients were reporting migraine relief after undergoing cosmetic browlift surgery. Research later showed that release of the supraorbital nerve, which is commonly done during browlift surgery, was the reason for this improvement.
We now know of several nerves around the skull that could be contributing to migraine headaches. The most common nerves involved are the greater occipital and the supraorbital nerves, but other nerves could be involved, including the lesser occipital, the zygomaticotemproal, and the auricultemporal nerves.
Surgical decompression of the peripheral sensory nerves around the skull can have a beneficial effect on the frequency, severity and duration of migraine headaches. In addition, many patients report a significantly reduced medication use. Surgery is either an outpatient procedure, or the patients spend one night in the hospital.
What causes the nerve compression?
The nerve could be compressed by muscle, bone, blood vessels, ligaments or scar tissue. For example, the supraorbital nerve is commonly compressed by the corrugator muscle located under the eyebrow. This can cause headaches around the eyes and in the forehead. The greater occipital nerve located on the back of the neck has six different compression points, including the semispinalis muscle, the trapezius muscle, and the occipital artery.
Who is a candidate for migraine surgery?
Several other factors are considered, including the efficacy (or failure) of medical treatment, side effects of medications and the severity of the migraines. Patients with a favorable response to Botox® or local anesthetic injections are generally good candidates for migraine surgery.
A typical pre-operative appointment lasts 45 minutes. The aim of this visit is to identify which nerve or nerves trigger the migraine headaches. This will include a thorough history and possible injection of Botox® or local anesthetics at different sites. The surgeon will review the patient’s “migraine diary” or ask the patient to start recording the intensity and duration of the migraines.
What are the side effects of surgery?
Most complications are temporary, and will vary according to the specific surgery. These include hyposthesia and numbness in the forehead and scalp, failure of the surgery to help the pain, neck pain and stiffness and wound healing problems. Treatment of migraines around the eye might actually improve the appearance of the forehead by decreasing wrinkles and correcting sagging eyebrows. Most of the incisions are well hidden, either in the scalp or in the upper eyelid.
How long is the recovery?
Slight bruising and swelling may occur, and typically resolves within two weeks. Most patients are able to return to their usual activities in the same time frame. Depending on the specific nerves targeted by surgery, patients might be asked to avoid strenuous exercise for up to three weeks.
What is the surgery’s success rate?
Most studies have shown success rates above 70 percent. Based on the patient’s specific clinical presentation, we might quote him / her a higher or lower success rate. When successful, patients report an improvement in migraine frequency, duration, intensity and in health-related quality-of-life.
Follow up care
Patients are typically seen at 1 week, 1 month and 6 months after surgery. At 1-2 months after surgery, patients can resume care with their primary care provider. After that time, many patients experience a significant reduction in pain, and their migraines are much more manageable. Some patients may come off medication completely.
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