Doctors and patients can come from worlds apart. When your migraine specialist says you don’t have anything life-threatening, it doesn’t mean he (or she) doesn’t believe in your headaches. Rather, it likely means they are trying to reassure you so you don’t stress and make the headaches worse in the process.

Often, patients don’t understand what doctors say and they don’t always feel comfortable enough to ask questions. Alternatively, they might not take notes and later not be able to retain some vital aspects of the discussion.

If you’re considering having migraine surgery, it’s vital to ask your specialist all the questions you need answers to, and to find a way to remember everything he says. These 5 questions (and the potential answers you’ll receive) will help to get you started:

Q1: Is Surgery My Last Option?

A: Migraine surgery is usually only considered once patients have explored all alternative forms of treatment. These typically include:

• Antidepressants and other drugs that are sometimes used in the treatment of tension headaches, with varying degrees of success. Typically, your doctor will have already tried various medications by the time you begin to consider migraine surgery, so you may already be past the point of trying anything else new. Drugs such as Zoloft, Wellbutrin and Celexa can cause a range of side effects, so it may be necessary to weigh up the benefits of treatment against any disadvantages. If you’ve previously tried antidepressants and other drugs without success, or are unable to use them due to the side effects, then surgery might be a good option for you.
• BOTOX treatments, which are approved by the FDA for migraine relief. Although they provide instant improvement, the results aren’t always effective in the long term. The treatment consists of the injections typically given to fight wrinkles, and it works by paralyzing the muscles in your forehead. You may still experience migraines but the muscles are unable to tense up and put pressure on your nerves. The treatment is fairly expensive and must be given every three to six months. Because of the risks associated with being dependent on ongoing treatment for pain relief, BOTOX is best used on a short-term basis to pinpoint muscles to target during migraine surgery.
• Clinical massage, which is a preventive tool for managing daily stress that can trigger migraine headaches. Various methods of massage have been proven to reduce pain in the joints, muscles and head and is covered by most insurances.

If none of these therapies has proved to be substantially beneficial, then it may be time to consider surgery.

Q2: What Are the Risks and Side-Effects of Migraine Surgery?

A:  Migraine surgery is performed endoscopically through small incisions in your scalp, so it’s minimally invasive. Pain and bleeding are reduced and the risk of infection is low. Some of the risks you should consider, however, are potential nerve injury that may cause temporary stiffness in their facial muscles, a decreased ability to move their eyebrows, some hair loss at the site of the incisions, swelling and bruising after the surgery and slow healing times for patients with conditions such as diabetes.

Q3: What Types of Migraine Surgery Are There?

A: There are five different types of surgery, all of which are minimally invasive and usually done on an outpatient basis. M.I.S.O.N. surgery relieves pressure on the nerves in your forehead, while M.I.G.O.N.E. surgery focuses on the nerves at the back of the head. Septoplasty is a procedure to correct a deviated nasal septum and relieve pressure on the nerves around the nasal cavity that causes headaches, and neurostimulation entails the implantation of electrodes under the skin that prevents the nerves from sending pain signals to the brain. The fifth type, a nerve block, is not actually surgery but is the injection of pain medication directly into the nerves causing the headaches.

Q4: What’s the Success Rate for Migraine Surgery?

A: Every case is different, but research from Harvard Medical School has shown a generally positive response from 90.7% of migraine surgery patients. Just over 51% of the patients were cured completely of headaches, while around 20% of the patients had an 80% improvement in their symptoms. Almost all of the remaining patients saw at least half of their symptoms resolved.

Q5: Can I Talk to Other Patients Who Have Had Similar Procedures?

A: Many patients are happy to share their stories of relief after migraine surgery. HIPAA’s rules state that the patient will need to sign a release form before their contact details can be shared, but it’s a good idea to find out from others what to expect. Your migraine specialist can probably also provide you with information such as case studies, that will help you to determine whether this treatment option is right for you. 

Photo | coffee-cups-notes.jpg | by r. nial bradshaw | Used under Creative Commons image attribution license 2.0