Migrane Surgery

 

Introduction

If less-invasive options for migraine treatment don’t provide the relief you need, migraine surgery may be an option to consider discussing with your Physician.

INDICATIONS FOR SURGERY

Migraines have long been associated with the compression and irritation of key nerves in your face and head. These triggers may be chronic, may have genetic causes, just the way your personal anatomy is put together, or may be the result of changes that take place over time. Surgically relieving the pressure on compressed nerves may reduce the frequency, severity and duration of headaches, or even eliminate them altogether.

Ideal candidates for surgery are:

  • Patients who have been diagnosed with migraines by a neurologist or their primary care doctor (not all headaches are migraines)* Holter monitor
  • Patients with sites of nerve compression identifiable through a clinical exam or diagnostic injections

DEVELOPEMNT OF THE SURGICAL TREATMENT FOR MIGRAINES

In the early 2000s, plastic surgeon Bahman Guyuron, M.D., observed that patients who suffered chronic migraine (at least 15 headaches per month for at least three months) frequently reported fewer headaches—or none at all—after undergoing certain cosmetic procedures such as brow lifts. He conducted research, and developed the theory that migraine pain is caused by inflamed trigeminal nerve branches in the head and neck. These nerves become irritated when surrounding tissues, such as muscles and fascia, apply excessive pressure. Dr. Guyuron believed that if a patient’s specific trigger sites could be pinpointed, surgical intervention might stop the irritation, which could reduce inflammation and possibly eliminate the migraine trigger.

TRIGGER POINTS

There are four sites generally considered to be likely trigger points. Each has a specific surgical procedure to treat the pressure and irritation.

  • Frontal headaches(starting above the eyebrows) may be caused by irritation of the supratrochlear and suborbital nerves in the glabellar area. The surgeon endoscopically resects the corrugator and depressor supercilii muscles through a tiny incision.
  • Rhinogenic or nasal headaches(behind the eyes), may be treated with a septoplasty (see Types of Migraine Surgery below).
  • Occipital headaches(originating in the back of the neck) may be caused when the greater occipital nerve is impinged by the semispinalis capitis muscle. During surgery the muscle is resected and the nerve shielded from further irritation.

HOW DOES IT WORK

Migraine surgery may reduce the irritation and compression of trigger nerves, either by correcting the tissue surrounding the nerves or by blocking the pain signals.

SURGERY – NERVE RELEASE

The tissue surrounding a nerve—the muscle, fat, or other structures—can impinge or compress the nerve and trigger migraine pain. Since a number of different nerves can be triggers, there are several different types of corrective surgeries. The surgery that may work for you depends on many factors such as the location of your personal triggers and pain.

  • Supraorbital nerve compression The supraorbital nerve is a network of tiny nerve endings in the forehead. It’s a common site where nerve compression can trigger migraines. Surgery is done endoscopically through tiny incisions in the scalp and around the eyebrows – normally within the hairline. The goal is to alleviate pressure on this specific nerve. Sometimes it could be pressure from the corrugator muscle, or the little tiny hole (foremen) the nerve pierces through. It could be scar tissue. Patients usually describe severe pain in the back of their eye. They often rub the area around their eye brow for relief. People describe it as “ice picks” jabbing their eye, and light sensitivity is very common (photosensitivity).

LEGEND: Endoscopically release of the supratrochlear nerve and excision of the corrugators muscle

  • Occipital Neuralgia, are the common pains associated with the back of the head and neck. Tight neck muscles and their outer tissue layer known as fascia are usually the cause. The procedure we perform, we have adapted the acronym, M.I.G.O.N.E., or Minimally Invasive Greater Occipital Nerve Entrapment.The greater occipital nerve provides sensation for much of the back and top of the head (and can cause pain as far forward as the eyes). It’s also a common site for migraine triggers. The surgeon removes enough of the tissue surrounding this large nerve to free it and allow it to function normally. This procedure takes about 2-3 hours to perform.

 

  • Septoplasty, or surgical correction of a deviated septum. The nasal septum is the cartilage and bone structure that divides the nostrils, and it’s not uncommon for it to be deviated, or bent. That puts pressure on the nerves that pass through it, and can trigger headaches. Septoplasty straightens the cartilage and relieve the pressure.

RESULTS

Please note, there are no guaranteed results for migraine surgery and results may vary. In a study published in Plastic and Reconstructive Surgery, 88% of the patients surveyed five years after their migraine surgery reported at least 50% reduction in the frequency, severity and duration of their headaches. The University of Wisconsin–Madison reports studies showing success rates greater than 70%, with about a third of those patients reporting their headaches eliminated completely.

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.

RISKS

While these surgical procedures are minimally-invasive, every surgery involves risk. You may experience side-effects, and complications are possible. If you have any questions or concerns, please be sure to discuss them with your physician. 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.