Migraine Surgery: Types, Effectiveness, and What to Expect

What Is a Migraine?

Ever experienced an intense, disturbing headache that makes your eyes sensitive to light or drives you nauseous? Then it could be migraine, and these sensations, which begin right before the headache, are called auras.

What Is Migraine Surgery?

Migraine surgery is a procedure that eliminates or prevents migraines by decreasing the frequency and intensity. Migraines can result from pressure on some nerves and blood vessels inside your head. During the operation, physicians relieve the pressure points, which can diminish the intensity of your migraines or eliminate them.

These pressure points are referred to as trigger points. You might have one or more trigger points, depending on what you have. The most usual ones are:

• Frontal - Pain above your eyes or your forehead.

• Temporal - Pain over your temples.

• Rhinogenic - Pain within your nose that can spread behind your eyes.

• Occipital - Pain at the back of your head that can spread across your skull or behind your eyes.

When Does a Migraine Become Chronic?

As per the International Headache Society, if a headache occurs for 15 or more days for more than three months with features of migraine for eight days or more, the condition can be categorized as chronic migraine.

Who Is Suitable for Migraine Surgery?

Migraine surgery is not for everyone; it is a personal decision based on your symptoms and medical history. You might be a good candidate if:

• You Have a Proper Diagnosis: Not all headaches are migraines! A neurologist should confirm that you have migraines or occipital neuralgia before considering surgery.

• Other Treatments Haven’t Worked: If you have already tried things like medications or behavioral therapy without success, surgery might be worth looking into.

• You’re in Good Health: Being in generally good physical health is important for a smooth surgery and recovery process.

• You Have Realistic Expectations: Surgery can help reduce migraines, but results vary. It’s important to go in with an open mind and understand that improvement may take time.

Other Migraine Treatments to Consider Before Migraine Surgery:

Before going for surgery for migraine, it is best to explore other alternatives. Some individuals get relief through non-surgical treatment, medication adjustment, or other lifestyle changes. Try out these few alternatives before opting for surgery:

• Neuromodulation Devices: Electromagnetic or electrical pulses are used by neuromodulation devices to activate the nerves that cause migraines. They can be used to either prevent migraines or reduce their pain when they occur. They are FDA-approved and non-invasive.

• Lifestyle Modifications: Lifestyle modifications, such as optimum hydration, eating clean food, and getting enough sleep, can control migraines. Vitamin B-complex and magnesium supplements have also been found to prevent headaches.

• Alternative Approach: Certain alternative therapies, like acupuncture, have been found to prevent migraines. Essential oils like peppermint have a calming effect on the ache. Yoga and light exercises can help with stress and correct posture, thus helping with migraines.

Before trying anything new, make sure it is safe and appropriate for you by talking to your doctor!

What Are the Different Surgical Techniques for Migraines?

1. Peripheral Neurolysis:

• Neurolysis or removal of the injured nerve of sensory branches of the trigeminal and occipital nerve (nerves that supply the face and back of the head) is done.

• Nerve decompression or nerve liberation is a technique in which the surgeon removes a small part of the tissue, muscle, blood vessel, or bone to relieve the nerve. The nerve decompression occurs in the trigger target regions (frontal, occipital, and temporal regions).

2. Septoplasty:

• Septoplasty is a surgical procedure that straightens a deviated septum, the cartilage and bone that separates your nostrils. If crooked, the septum can cause blockage and even lead to headaches.

• The concept of migraine septoplasty is that making the airway wider might decrease pressure and, in turn, diminish headache symptoms. Experts, though, have different opinions regarding its success.

• There is not yet enough evidence to prove a direct connection between migraines and a deviated septum. If you are looking at septoplasty as a remedy for headaches, you should see a doctor to decide whether or not it's what you need.

3. Turbinectomy:

• Turbinates, tiny structures inside the nose that help humidify the air we breathe, are removed during a turbinectomy.

• When turbinates become enlarged, they can lead to breathing difficulties and may contribute to headaches.

• More research is needed to confirm the effectiveness of turbinectomy in treating severe, long-lasting headaches or migraines.

4. Neuromodulation:

• Neuromodulation treatment is recommended for those patients who are not responding to treatment options like medications.

• It provides gentle electrical signals to particular nerves that induce pain in migraines.

• One technique used by many is occipital nerve stimulation (ONS). Doctors implant small electrodes at the base of the skull close to the occipital nerves. Physicians first attach these electrodes to a temporary stimulator to determine whether it relieves the problem. If the stimulator works, they then implant a permanent device that continuously sends mild pulses of electricity to suppress migraines.

• Other options include stimulation of different nerves, like the vagus nerve or the sphenopalatine ganglion, which may also help with migraine pain. If regular treatments haven’t worked for you, this could be something to discuss with your doctor!

5. Nerve Decompression Surgery for Migraines:

• Nerve decompression surgery for migraines, also called nerve release surgery, helps relieve migraines by releasing pressure on nerves under the skin. Plastic surgeons have been performing this surgery since the mid-2000s.

• Some nerves in the head or neck can become compressed by nearby muscles, tissues, or blood vessels. This pressure can trigger migraines, making them harder to control compared to common triggers such as food or sleep patterns.

• This treatment is generally reserved for individuals who have been diagnosed with a migraine disorder, particularly if other medications have proven unsuccessful. A healthcare provider or neurologist can decide whether or not it is the best choice.

• Nerve decompression surgery for migraine is an outpatient procedure.

• Surgeons work on relieving the pressure on the compressed nerves, which might be causing the migraine headache.

• This surgical procedure has given positive results in patients who didn't respond to other treatments; however, whether it is suitable for you or not should be discussed with your healthcare provider.

Let’s Have a Look at What Happens Before, During, and After Migraine Surgery

Before Surgery: Your surgeon will assess your medical history and previous migraine treatments and perform a physical examination to identify specific trigger points causing your migraines. This evaluation determines your eligibility for the surgery. Botox (25 units) is injected into specific head muscles to block pain signals, with doses varying by site. It provides short-term relief and helps identify candidates for surgery, but it isn’t for long-term use due to resistance.

During Surgery: The surgery typically lasts between one and five hours, depending on the number of trigger sites addressed. It is performed under general anesthesia, and most patients can go home the same day or may stay overnight in the hospital.

After Surgery: Some discomfort is normal post-surgery, and patients may experience a migraine; however, there is usually not much pain at the surgical site.

• To facilitate proper healing, patients are advised to limit physical activity and avoid strenuous exercises for at least three weeks.

• Your first follow-up visit will be five to seven days after surgery. Further follow-ups are scheduled at approximately three weeks, three months, six months, and one year to monitor progress and address any concerns.

• Recovery goes on for a few weeks as swelling subsides and nerves recover. It is important to adhere to your surgeon's advice and visit all follow-up appointments to achieve the best recovery.

Expected Outcomes: Many patients experience a significant reduction in migraine frequency and severity shortly after surgery, while others may require more time to notice improvements.

• Outcomes may differ; some people will continue to have migraines, but often less frequently or severely.

It is essential to communicate regularly with your physician during the recovery period to address concerns and achieve the best results.

What Are the Risks Associated With Migraine Surgery?

The most common risks associated with migraine surgery are as follows:

• Temporary muscle weakness at the injection site.

• A drooping eyelid, which usually goes away on its own.

• Weakness in neck muscles.

• Small risk of a nerve lump (neuroma) forming.

• Temporary numbness, tingling, or itching at the surgery site.

• Low chance of bleeding or infection.

• Nosebleeds after surgery.

• Sinus infections or nasal dryness.

• Possible bending of the nose’s middle wall (septal deviation).

• Risk of the electrode moving if not properly secured.

• Infection risk - usually treatable with antibiotics, but in rare cases, implant removal may be needed.

How Reliable Are Migraine Surgeries?

The American Headache Society (AHS) does not recommend surgical treatment for migraines except in cases of clinical trial participation for the following reasons.

• Extensive research is required on the subject (large multicenter studies should be done).

• Unknown long-term complications.

Final thoughts

Migraines are severe headaches that can drastically impact a person's day-to-day life because of their pain and other symptoms, especially if it is chronic. Most physicians and researchers recommend that one should always opt for medical management and behavioral therapy first, as surgical options still require extensive research on large control groups and pose risks. Therefore, migraine surgery should only be considered for intractable chronic migraine on recommendation by the physician and surgeon.

Key Takeaway From iCliniq:

Migraine surgery can be helpful in some individuals, but it might not be the case for all due to the risks involved following the surgery. Another disadvantage is that most of the insurance plans don’t cover migraine surgery, so before going for surgery, it is better to explore other treatment options like medications, lifestyle modifications, etc. Your doctor can help you decide if surgery is the right choice for you. To learn more or talk to a doctor, visit icliniq.com.