The disabling pain of migraine disrupts families, ruins social lives, and restricts career paths. Depending on the severity of the migraine, sufferers live in a world of pain with only occasional bouts of relief. It’s no way to live your life.
Conventional medication helps many, along with lifestyle and pain management strategies. For others, surgical interventions can provide more long-term relief.
Qualifying For Surgery
Not everyone who sufferers from migraine automatically qualifies for surgery. First, you need to be sure your headaches are migraine, and that means official diagnoses by specialists who take into account all the details of your family history, symptoms, causes, potential triggers and frequency.
For anyone at the beginning of their migraine journey, it’s necessary to realize from the outset that there is no quick cure, and often not even a quick diagnosis. Although doctors and other health care providers may have a strong belief that your pain is migraine, there are various tests and analyses before diagnosis is confirmed.
Even then, migraine surgery is not the first option. Patients are considered for surgery when standard or conventional medications have failed, or are mostly ineffective.
Botox is an increasingly popular form of migraine treatment, discovered when diverse Botox patients reported a decrease in the frequency or severity of their migraines following treatment. Now, responsiveness to Botox is a strong indication that surgery could provide more long-term relief. While surgical procedures can cure many conditions, it’s not a guaranteed cure for migraine. Most Botox recipients respond well, although it should be considered a treatment rather than a complete cure.
Types of Migraine Surgery
There are various surgical procedures designed for migraine relief, falling into two main categories: pain blocking and nerve release.
Tiny electrodes are surgically placed under the skin around the nerve that triggers pain. These are wired up to a battery that is also under the skin. The small electrical impulses stimulate the nerve and prevent larger pain signals getting through to the brain.
Often, a temporary surgery is performed to evaluate the success of this migraine treatment, with a permanent implant following if the procedure is deemed effective. This neurostimulation is similar to that used in the treatment of other painful conditions such as for people with spinal injuries or other causes of back pain.
All surgery for nerve release is minimally invasive, going only as far as the nerves just under the skin. At no point during surgery is the skull drilled or the brain operated on.
The operation, on the occipital or trigeminal nerves, is performed on an outpatient basis, although general anesthetic is normally given. The incisions are small, with the nerve release performed via endoscopy. There are few scars, and these are hidden either in the scalp beneath the hair or, depending on the trigger site being treated, in the upper eyelid. Some patients find there are positive side effects, such as a reduction in the visibility of wrinkles around the eyes or forehead, or a lessening of sagging around the eyebrows.
The two main areas for nerve release surgery are:
- The Supra Occipital Nerve: This is a network of nerves that end in the forehead. Compression of this nerve is a common cause of migraines, and the surgery releases the pressure.
- Greater Occipital Nerve: Surgery aims to release pressure on this nerve, which is responsible for sensation in the back of the neck, up across the head and over the forehead.
A separate cause of migraine pain is sometimes a deviated septum (the cartilage in the nose which separates the nostrils). Septoplasty (the surgical procedure) corrects the deviation and can alleviate migraine pain.
Risks and Recovery
As with all surgical procedures, there are some risks and these include:
- Nerve injuries
- Problems with healing of the wounds
- Failure to improve headache severity or frequency
Most patients recover within a couple of weeks and resume their normal daily activities. It takes this long for any swelling or bruising to subside. It’s possible that you’ll be asked to avoid strenuous activity or exercise for a few weeks, depending on the surgical site and the nerves affected.
The surgery removes the triggers caused by compressed nerves, not the cause of the migraine. Whilst around 90% of the patients who undergo surgery to decompress their migraine trigger point nerves experience some relief, it’s only about half of those whose migraines are completely cured.
Most people who undergo migraine surgery will still need to manage other triggers, such as light or sound, as well as continuing with other migraine managing strategies.
If you’ve tried various treatments in an effort to get migraine relief, it might be a good time to consider your surgical options.
Dr. Mark Khorsandi works at the Migraine Relief Center. They provide surgical treatments that reduce and eliminate pain for migraine sufferers.