In some cases where migraines are particularly severe or frequent, the patient may opt for migraine release surgery. Manish H. Shah, MD, FACS, of Shah Aesthetic Surgery in Denver, Colorado, performs migraine release surgery, a procedure that is used to decrease pressure on sensory nerve fibers located between the eyes, in the temples, at the top of the posterior cervical spine (back of the neck), and inside the nose. This is a relatively new migraine treatment which, unfortunately, is not routinely covered by health insurance companies. It is not a well-known option for most patients.
Dr. Shah explains, “The theory behind the procedure is that there are areas of pinching in the nerve fibers that reduce blood flow and oxygen to the nerves stimulating pain signals.” He says, “These areas of pinching are known as the extrinsic causes of migraines. The concept is very similar to carpal tunnel syndrome in the hand.”
Minimally Invasive Surgery for Migraines
The procedure itself is delicate work focusing on key pain areas. It addresses several “nerve bundles” at various points on the face and head, taking pressure off of them to enhance blood flow. The first two bundles of nerve fibers are approached using an endoscopic browlift procedure that lifts the forehead to expose the nerve fibers. The third bundle of nerve fibers is approached directly using an incision in the hair-bearing scalp at the top of the neck. The final bundle of nerve fibers is addressed using a rhinoplasty or septoplasty procedure to correct anatomic abnormalities within the nasal cavity.
Rhinoplasty and septoplasty are surgical procedures that correct the nasal structure. Rhinoplasty is used to correct the form or function of the nose while septoplasty addresses any issues with the septum (the cartilage and bone that divides the nostrils). Intranasal abnormalities that can cause headaches can range from sinus and allergy issues to tumors and abscesses.
Who is a Candidate for Migraine Release Surgery?
Typical patients who have high success rates with migraine release surgery meet the following criteria:
- They have 9-15 days of migraine pain per month
- They have a neurologist who manages their symptoms using standard migraine medications
- They do not routinely use narcotics to manage their pain symptoms
- They are not involved in disability evaluation or lawsuits with regards to their headaches
- They have a positive response to Botox or local anesthetic injections to the nerve fibers involved in their headache syndrome with a documented reduction in number of days per month of migraine pain if injected with Botox, or immediate relief of pain if injected with local anesthetic.
Patients who are interested in exploring the possibility of migraine release surgery need to work with their plastic surgeons to submit the correct ICD-10 and CPT codes to their insurance companies. If authorized, and if performed on the right patient, 50% of patients have long-term remission of migraine headaches, and a further 42% have a sustained, significant reduction in migraine headache days. The overall success rate with the procedure is 92%.
While in its infancy, migraine release surgery raised some doubts, but over time that tide has turned. Recent studies show that the procedure can bring much welcome relief to people who suffer from debilitating migraine pain. It is a proven effective treatment giving migraineurs hope that they can have a better quality of life with a pain free tomorrow.
Axon Optics. “Everything You Need to Know About Migraine Surgery.” Axon Optics, 2016, www.axonoptics.com/2016/03/everything-need-know-migraine-surgery/.
Axon Optics. “What Migraine Medications Are Available to Me?” Axon Optics, 2017, www.axonoptics.com/2017/08/migraine_medications_available/ .
Mendonça, Jeferson Cedaro de, and Ivo Bussoloti Filho. “Craniofacial Pain and Anatomical Abnormalities of the Nasal Cavities.” Revista Brasileira De Otorrinolaringologia, SBORL, www.scielo.br/scielo.php?pid=S0034-72992005000400022&script=sci_arttext&tlng=en .
“Surgical Deactivation of Trigger Sites Leads to Long-Term Migraine Relief.” Clinical Pain Advisor, 2017, www.clinicalpainadvisor.com/migraine-headache/migraine-relief-obtained-with-surgical-deactivation-of-trigger-sites/article/674935/.