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Migraine Surgery vs. BOTOX: Pros and Cons

Posted by Migraine Relief Center on Feb 25, 2015 7:00:00 AM
Migraine sufferers can now choose between various treatment options. Since every individual patient experiences migraines differently, it’s important to remember that what works for one person doesn’t necessarily work the same way for another. The two primary treatment types we use currently to reduce the effect of migraines are BOTOX and migraine surgery. Both methods have distinct pros and cons, and you’ll need to have your migraine doctor carefully assess the treatment that’s most likely to be effective for you.

BOTOX Treatment

While BOTOX was originally used for cosmetic purposes as a solution to a wrinkled forehead, advanced research quickly identified a range of other uses for the process.

How It Works

BOTOX is a nerve toxin made from a type of bacteria, which causes a life-threatening food poisoning condition called botulism. The condition results in paralysis of various muscles, including those in the respiratory system, the arms, legs and torso. When the toxin is injected into your forehead, it blocks the release of the chemical that instructs your muscles to contract. The muscles relax instead, which “smoothes out” the area surrounding the injection site, decreasing wrinkles and frown lines and giving you a more youthful look.

The use of BOTOX for migraines follows the same principle, causing your muscles to relax and avoiding the tension that can result in a migraine. Patients receive BOTOX once every three months over a 15-month period, with doses injected at various points in your forehead, temples, neck, upper back, back of the head and the bridge of your nose.


BOTOX is a quick, painless treatment that doesn’t require hospitalization. Sessions last between 10 and 15 minutes and the only discomfort is a few pricks with the needle.

Complications are rare and practically non-existent when the therapy is administered by trained health care professionals.

The cost of BOTOX for treatment of chronic migraine is covered by most insurance providers, although it’s best to get confirmation of this before you proceed. In some cases, insurance companies will request trying other methods before they approve reimbursement of BOTOX.


It takes between 10 and 14 days after the first set of injections for most patients to start experiencing relief, and some patients don’t get relief at all at that stage.

Some patients develop side effects, such as:

  • Stiffness at the site of the injection
  • Neck pain
  • Headache
  • Temporary muscle weakness in the neck and shoulders

The side effects usually disappear after a few days.

Migraine Surgery

Surgery to treat migraine patients was discovered almost by accident when patients who had cosmetic brow lift surgery noticed their headaches dissipating afterwards. This resulted in the development of several surgical procedures for sufferers, depending on the location of your individual trigger sites.

How It Works

The various surgeries used for migraine relief all target specific nerves in the scalp, which get pinched and compressed by surrounding tissues. There are five types of migraine surgery, all of which target different areas. The surgery involves small incisions in the scalp or nasal passages, which is usually done under general anesthetic. The surgeon uses an endoscope to relieve the pressure on either the supraorbital or the greater occipital nerves, which reduces both the frequency and the severity of the migraine headache pain.


Migraine surgery is an outpatient procedure that takes very little time. Surgeons use an intracranial method, so the process is minimally-invasive. Complications are rare and patients usually go home the same day. Approximately 30% of patients have complete resolution of their headaches, while 90% experience relief that lasts up to five years. In those patients who didn’t get complete relief, attacks have been shown to reduce in duration from 34 to 8 hours and in frequency from 11 attacks a month to four.


There are risks to any surgical procedure, especially those that require general anesthetic. Potential complications, while rare, can include:

  • Bleeding, infection and scarring of the wound
  • Ongoing headaches and pain
  • Scalp numbness and an inability to frown
  • Forehead asymmetry and swelling of the eye area
  • Hematoma and bruising

Even though it’s an outpatient procedure, you will need help getting home because of the effects of the anesthetic.

Making a Decision

While both BOTOX and surgery offers hope of relief for migraine sufferers, it’s important to note that neither procedure is a foolproof way to cure headaches completely. While some patients do experience up to 90% improvement, this may not happen in your case. If you have tried various other therapies without success, it may be worth considering migraine surgery or BOTOX to get some improvement.

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Topics: Treatment

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