Is Migraine Surgery Right for Me?

When you’re suffering from regular and repeated migraine attacks that seriously affect your quality of life, the chance that migraine surgery may reduce these is an attractive option.

Migraine isn’t the kind of condition that has any one cause or treatment. For this reason, whether surgery offers a viable and realistic chance of relief depends very much on the individual.

Since surgery for migraine first became available, various types of procedure have evolved to address different migraine causes and triggers. Regardless of the patient’s trigger, however, candidates also need to meet other medical criteria, including physical causes.

Neurological Migraine Causes and Surgery Types

Nerve compression is a frequent migraine trigger, which is why it’s important your care is undertaken by a neurologist (neuro comes from the Greek, meaning the nerves or nervous system) with particular, specialist migraine knowledge.

Tissues such as the muscle or fat surrounding the nerves can sometimes press against them and cause compression. It is this compression that triggers migraine pain. Unfortunately, migraine can have multiple triggers so reducing the compression through surgery may not totally stop migraine headaches. Many patients, however, experience a marked improvement following surgery, of which there are several types depending on the targeted nerve.

The nerves in the forehead, along with those in the back of the head or the face are the common trigger points for migraine pain. When compressed nerves in the forehead trigger pain, surgeons may carry out the M.I.S.O.N (minimally invasive supra-orbital nerve) procedure. This helps reduce the pressure on those nerves, often providing long-term relief. The other main site affects the occipital nerve located behind the head. A different procedure, called M.I.G.O.N.E. (minimally invasive Greater Occipital Nerve Entrapment), reduces pressure on these nerves.

Neurostimulation is also effective. Back in 1965, a published theory stated that nerve fibers react to two different kinds of stimulation: touch or pressure, and pain. Most of us recognize the truth of this, since the automatic reaction to pain is to apply pressure to the site, with the pressure creating an alternative sensation that reduces the pain stimulus. Implanted neurostimulators that release a gentle vibration will often reduce pain levels in patients.

Surgical procedures that target the frowning muscles (officially known as the corrugator supercilii muscle group) can treat frontal migraine headaches, and Botox is often used as an alternative to surgery.

Yet another type of migraine surgery that may help those with sinus-related migraine is ENT (ear, nose and throat) surgery, to correct a deviated septum or clear sinuses with a balloon.

Is Migraine Surgery Right for You?

Since there are several types of migraine surgery available, there is no ‘one size fits all’ approach. Every migraine sufferer needs to have an individual assessment to determine their suitability for surgery. Assessment criteria are quite specific and strict, especially if you want your insurance to cover the cost. These include:

• You must have an official migraine diagnosis and be under the care of a neurologist with specialist migraine knowledge. While the procedures themselves are not complicated compared to many modern surgeries, it’s vital you have this expert and specific medical guidance. Specialists can identify whether your pain stems from a frontal headache, is a temporal headache, occipital or rhinogenic. Establishing the causes helps determine the next steps and influences choices of treatment and medication.
• You need to have exhausted just about every other, non-surgical type of treatment. This process can take several years, because there are many different alternative migraine medications and each must be given time to assess its effectiveness. If preventive or abortive (or both) drug therapies provide effective relief, you may not be considered a suitable candidate for migraine surgery.
• Monitoring your symptoms, your triggers and the frequency of attack over time also helps doctors to establish your migraine pattern. You do this through a detailed migraine diary.
• Often, you may try alternative procedures that work to numb the nerves. Injections in the forehead (targeting the corrugator supercilii muscle group) such as Botox, or an occipital nerve block if the nerves in the back of the head or neck are responsible for your pain, are two examples. These less invasive procedures will help determine the likely success of the full surgery.

Overall, surgery for migraine targets only one possible cause, and because there can be multiple attack triggers, a total cure with surgery is not guaranteed. Migraine surgery to relieve pressure on nerves offers many patients worthwhile relief, however, so don’t be afraid to discuss the option with your neurologist. He or she is the best person to help you decide when the time for surgery is right.