Surgical interventions for migraine are becoming more popular as the number of patients who successfully undergo the procedure increases. Medicine naturally evolves and becomes more effective as knowledge deepens through research and data gathering, but there is still some confusion around the question of undergoing surgery for migraines.

Migraine is a debilitating condition, with high costs to individuals in terms of poor quality of life and lost income through sick days. The cost to employers is high too, since they lose working hours when migraine-suffering employees cannot carry out their normal routine.

Affecting millions of people in the USA alone, migraine is such a widespread condition that new research for causes and cures is ongoing.

How Migraine Surgery was Discovered and Developed

Some twenty-odd years ago, triptans became available and are still prescribed today for migraine treatment. They work for some, but not all.

More recently, BOTOX injections have been found to bring migraine relief in some patients. As often happens in medicine, the migraine relieving properties of Botox only came to light when some patients reported a reduction in the frequency of their migraines following cosmetic Botox treatment.

Botox treatment typically consists of 31 small injections into various areas of the head and neck, and although it’s not totally clear why this helps with migraine, it’s thought that the Botox blocks or reduces nerve signals that cause migraine pain.

Forward-thinking surgeons began to wonder if a similar surgical procedure would give more long lasting results than Botox treatment, which typically requires repeat treatments every few months in order to stay effective.

Dr Elena Ocher, the executive director of NY Migraine Associates, teamed up with plastic surgeon Dr. Kaveh Alizadeh, and together they found a study produced by the Cleveland Clinic. The results of the study, conducted over five years, examined how effective surgery was in decompressing the nerves at migraine trigger sites. The vast majority (61 out of 69) of patients taking part in the study reported a positive outcome, with 90% claiming that five years later their migraine had either gone completely or were significantly reduced.

Does Anyone Qualify for migraine Surgery?

Unfortunately, not all migraine patients are suitable candidates for surgery. This is only to be expected given that there are so many different types of migraine, with many different triggers and differing levels of severity or frequency.

Patients considering nerve decompression surgery for migraines are put through a careful selection process to determine whether the procedure would benefit them.

• Crucially, migraine must have been properly diagnosed by a neurologist. Some patients are self-diagnosed, but not all severe headaches are migraines.
• Patients have normally shown no or little response to more traditional forms of treatment, or must have severe side-effect reactions to other medications.
• The patient will commonly have shown a good response to either local anesthetic injections or Botox treatments.

Side Effects and Recovery from Migraine Surgery

Surgery is usually performed on an outpatient basis, and may take as little as one or two hours depending on the number of trigger sites being treated. This is not brain surgery and no skull penetration occurs.

The incisions are small, and usually hidden in the hair line or upper eyelid. Recovery is generally complete after just a couple of weeks, and patients are able to resume normal daily activities after this time. Positive side effects are also possible following surgery, including a reduction in forehead wrinkles and firmer eyebrows.

Any negative side effects are minimal, but may include healing problems or more rarely, nerve injury. The greatest risk is that the treatment won’t reduce the frequency or severity of migraine headaches, although studies show success rates of higher than 70%.

Is Success Guaranteed?

Unfortunately, even in patients thought to be the perfect candidates for nerve decompression surgery, there is no total guarantee of success. The procedure is a treatment that is intended to minimize the impact of migraine on your general wellbeing and lifestyle. Total eradication of migraine is possible, but so is partial improvement or occasionally, no improvement.

How Do I Investigate Further?

As a first step, speak to your doctor and ask if you can investigate together how well you would do with migraine surgery. If imaging scans are suggested, ask that your surgeon reviews the results rather than relying on the reports returned by radiologists. CT scan findings in migraine patients are often seen as being within normal variants by radiologists, but those variants may be significant when looked at by a specialist with migraine experience.

Not all insurers cover migraine surgery, since some still view the procedure as experimental or controversial. Other companies do cover it, however, and if you’re considering a surgical option it’s worth talking to your doctor and reviewing your insurance.