You or someone you know probably know someone that suffers from migraine headaches. They are more common than many people realize. They are also more treatable – perhaps even permanently – then you might know. Relatively few people (even headaches sufferers) are aware that migraine surgery is a thing. For victims of chronic and debilitating migraine headaches, which are perhaps resistance to migraine medication, migraine surgery might be the solution that is needed.
Migraine surgery is a potential treatment option for individuals suffering from chronic migraines. This surgical procedure aims to alleviate or reduce the frequency, duration, and intensity of migraine attacks. The surgery typically involves targeting specific trigger points or nerves known to be associated with migraines. While the effectiveness of migraine surgery may vary for each individual, it has shown promising results for some patients in reducing their migraine symptoms.
Headaches
Headache disorder is a pervasive problem throughout the world. Headaches are considered the seventh most debilitating disease worldwide. They are estimated to affect over three billion people by the World Health Organization. Headaches thereby make up the third greatest neurologic disease burden affecting quality of life in the world. With such common occurrence, then, you might expect a cure to have been discovered long ago. Unfortunately, as with the common cold, that is simply not the case. Treatments are available for headache sufferers, which usually include medications, avoidance of specific triggers, and pain management.
Migraines
There are many different types of headaches, the most common of which are tension-type headaches, which are typically treated with over-the-counter non-steroidal anti-inflammatory medications (NSAIDs), like aspirin or ibuprofen. Migraine and cluster headaches, however, are usually more severe, are thought to have different causes, and often require prescription medications. Severe migraine headaches can occur with or without an “aura,” or change in neurologic function, such as vision, during a migraine event. Migraine attacks can typically also include:
- Pulsating Quality
- Aggravation by physical Activity
- Multiple hour or multiple day duration
- Sensitivity of light and/or sounds
- Nausea
The exact cause of migraines is not entirely understood but is thought to result from the release of pain-producing inflammatory substances around nerves and blood vessels in the head and neck. Certain foods, alcohol, and other environmental factors may also trigger migraines. Migraine headaches can be debilitating and affect approximately one in eight Americans.
Trigger Points
These nerves may be irritated, compressed, or stretched in such a way as to generate pain. This can be due to blood vessels, which often run parallel to nerve, connective tissue, or even bony compression points. Such compression can result in what are known as “trigger points.” Trigger points are focal locations at which the migraine headache sensation starts. Types of migraine headaches by anatomy and surgical approach:
- Frontal – pain above one or both eyes on the forehead
- Temporal – pain from one or both temples
- Rhinogenic – pain that seems to come from the nose and may extend to behind the eyes
- Occipital – pain from the back of the head that can radiate across the skull to the eyes
- Other – pain may be experienced starting from other locations as well
An individualized nerve can account for pain emanating from each of these trigger point locations.
Patient Selection
There are certain features of your migraine that may make it more prone to improvement from migraine surgery. Such as:
- Chronic, recurrent, and/or debilitating migraine headaches despite medical treatment
- Specific location of a trigger point
- Temporarily responsive to Botox® treatments
- Disruption to work, lifestyle, or mental health
It is also important to employ multidisciplinary care from a neurologist and/or pain medication specialist, preoperative medication weaning, preoperative care for any psychiatric comorbidities, and possibly post-operative physical therapy.
Migraine Surgery
You might hear the phrase migraine surgery and think there was a typo or misnomer. How can you operate on pain? In fact, migraine surgery can be a life-optimizing option for those who have found no relief with other conventional treatments. Discovered by a plastic surgeon who noticed the decreased rate of migraine headaches in his Botox® and rhinoplasty patients, migraine surgery typically is done to release compression or tension on various branches of nerves in the head and neck, so called cranial nerves. So, while it may feel like the pain is located inside the head, it is thought to come from nerve branching to outer portions of the head and neck on and around the cranium. It is the position of the American Society of Plastic Surgeons that peripheral nerve trigger surgery for treatment of refractory chronic migraine headache in properly selected patients is considered a standard, accepted treatment, citing nearly 20 years of peer-reviewed publications in high impact factor journals. The specific regions and nerves that are targeted for surgical decompression are:
- Frontal: supraorbital and supratrochlear
- Temporal: zygomaticotemporal and auriculotemporal
- Occipital: greater, lesser, and third occipital nerves
- Nasal: branches of sphenopalatine ganglion
- Nummular nerve branches
Migraine surgery essentially uses various craniofacial surgery approaches, such as modifications of a brow lift, rhinoplasty (nose job) and scalp surgery to target and release the nerves thought to be causing migraine headaches.
Expectations for Migraine Surgery
The goal of migraine surgery is to reduce or eliminate headache frequency, duration, and pain. This is achieved first by proper patient selection. It is important to have realistic expectations that pain may not be eliminated but rather decreased in frequency or intensity. Complete resolution of migraine headaches can occur. Most patients experience a reduction in the frequency and/or intensity of migraine headache pain.
Reach out to Us
If you or someone you know suffers from chronic migraine headaches, especially if they come from a focal place on the head and neck and are resistant to improvement with medication, then you may be a migraine surgery candidate. Dr. Kristopher Day, MD, is a craniofacial-trained, board certified plastic surgeon and member of the Migraine Surgery Society. He has received specialized training specifically suited to providing surgical relief from intractable migraine headaches. If you have questions, simply reach out to our office to learn what options may be available to you!
