Migraine Surgery

The goal of migrane surgery is to reduce or eliminate pain and frequency of headaches. Migranes can be associated with compression and irritation of sensory nerves and blood vessels in the head. When these compression points are released during surgery, the severity of the migrane may be reduces or even removed.

Nerve compression sites are also known as /„trigger points“/. You may have one or more trigger points, depending on the symptoms. The most common and main sites of migraines are frontal (forehead, pain above the eyes and/or forehead), temporal (pain abode the temple), rhinogenic (pain inside the nose that can spread behind the eyes), occipital (pain in the back of the head that can radiate towards your eyes or behind them). You may also feel pain in less common areas around your head.

Who is a suitable candidate for a migraine surgery?

Migrane surgeries require a very individual approach. Depending on the symptoms, you may have one or more places on your head where you need to release a nerve.

In general, you may be a suitable candidate for a migraine surgey if :

  • Your neurologist has diagnosed you with migrane or occipital/neuralgia (not all headaches are migranes!)
  • You have tried several therapies (drugs) without auccess
  • You are physically healthy
  • You have realistic expectations

What to expect during a migraine surgery examination?

During your examination, there are three main components that will determine if you are a suitable person for migrane surgery. First one is your past and present medical hisotry. This part of assessment is crucial because it gives the surgeon insight into what has led to the current condition and indicates how to avoid mistakes that have been repeated in the past. Secondly, you should prepare for a systematic examination, which will be focused on the symptoms and possible places of compression of the head, which cause migranes. Thirdly, you will undergo diagnostic test, such as nerve blocks/local anesthetics or botox injections, to confirm whether peripheral nerve pathology is a factor in your migrane symptoms.

As for your medical history, during the examination you should be ready to discuss about :

  • Medical treatments you have tried in the past to treat migraines
  • Your other current and previous medical conditions
  • Your drug allergies
  • current medicines, vitamines, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries or injuries that are or aren’t related to migrane surgery
  • Your work history and overall lifestyle

Regarding the physical examination, your plastic surgeon will :

  • Perform a review of several organ systems
  • Perform a focused examination of the peripheral nerves of the head and neck

Regarding the diagnostic testing, your plastic surgeon will :

  • Review all previous imaging studies (MRI, CT scan)
  • • Look at any previous procedures or therapies you have had
  • Take photos

At the end of the examination, your surgeon will consider the possibilities and recommend the method of surgical treatment, discuss the outcome of the migrane operation, including the previous examinations and results. The success and safety largely depends on your complete honesty during the examination and on the results of previous diagnostic tests. Feel free to prepare a list of questions you would like to discuss with your plastic surgeon and take them with you for a consultation.

What are the risks of migrane surgery?

The decision to have a migrane surgery is extremely personal. You will need to decide if the surgery will achieve your goals and if the risks and potential complications of the surgery are acceptable. To this end, the plastic surgeon will and/or staff will explain in detail the risks associated with these surgical procedures and you will be asked to sign consent forms, in order to fully understand the operation (s) to which you will undergo. Possible risks of migraine surgery include: bleeding, infections, poor wound healing, hemorrhage, risks around anesthesia, skin discoloration and prolonged swelling of the operated region, visible scars, changes in skin sensitivity, fatty necrosis, asymmetries in muscle function, need for another operation … Feel free to discuss any potential risks with your surgeon.

How to prepare for a migraine surgery

Details of the preparation will be elaborated in the examination, which includes:

  • Laboratory examination and preoperative examination
  • Adjusting current therapy
  • Smoking cessation
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements, because they can increase bleeding

Migraine surgeries are performed in a hospital, under local or general anesthesia, or in a combination of local anesthesia and analgesia. Accompaniment should be provided in case of a one-day stay in the hospital, for transport and return home.

What are the steps of the migraine surgery procedure

Step 1 – anesthesia

One of these or a combination thereof : local anesthesia and/or intravenous sedation and general anesthesia

Step 2 – cut

The type of incision varies from the location of the trigger site (one or more) as well as the choice of the surgeon. Generally, your surgeon will use an endoscopic or open approach or open approach at the frontal trigger site. If your surgeon prefers an endoscopic approach, you will have three to five small (1,5 cm) incisions in the hairline above the forehead. If you undergo an open procedure, the incision will be in the fold of your upper eyelid. The same incision is used for upper eyelid blepharoplasty (upper eyelid rejuvenation). On the place of the temporal triggers, the surgeon who decides on the endoscopic approach will make two small incisions on the hairy part of the head. If the temporal trigger site is done with the frontal trigger site, your surgeon may use the same incision through the upper lid to do both trigger sites. Another option is to make a special, small incision in the temple. At the occipital trigger site, an incision is made vertically along the midline or horizontally over the back of the head. Incisions for rhizogenic/nasal migraine origin depend on the internal findings of the nose and approach chosen by your surgeon. There may be additional small incisions on the head if necessary, to cover all possible migraine triggers. Migraine surgery is individual and is performed based on your specific symptoms.

Step 3 – Close the incision

Closing the wound in layers.

What to expect during recovery from the migraine surgery?

After a migraine operation, you will have minimal bandages, if any. Care of the incision or incisions is important. Sometimes released nerves can be irritated postoperatively, which requires pain medication.
You will receive specific instructions that will indicate:

  • How to care for the surgical area after surgery that antibiotics reduce the risk of infection of
  • When to contact your plastic surgeon
  • When showering is possible
  • When it’s possible to continue with normal activities and exercise
  • When the return to work can be expected
  • When the threads are taken out

Healing will continue for several weeks, and the swelling will decrease for months, because the nerves heal. Continue to follow the plastic surgeons instructions and come for regular checkups.

What results should be expected after the migrane surgery?

Migraine surgery can reduce the frequency, duration and severity of migraines in appropriately selected patients. Studies have shown that between 70% and 95% of patients who have undergone surgery experience improvement or complete elimination of migraine headaches. Some patients notice an immediate improvement, others may notice the effect of the operation only after a few months. Medicine and surgery are not exact sciences. Although good results are expected, there is no
guarantees. In some situations, it will not be possible to achieve optimal results with one surgery, and another operation may be needed.
Sometimes, intense pain masks another area of pain. If you feel pain at the site of surgery or in another area, see a plastic surgeon. After good preparation, conversation and examination of the patient, the second and sometimes the third place of pain relief, in migraine, can be removed in the first operation.
When you go home, if you feel shortness of breath, chest pain or unusual heartbeat, seek immediate medical attention. If any of these complications occur, you may need re-hospitalization and additional treatment. Follow your doctor’s instructions, as this is key to the success of your surgery.