Migraines Are a Very Common Condition and Can Be Severely Debilitating
Migraines are a very common condition, with 15.3% of Americans aged 18 years or older reporting a migraine or severe headache in the previous 3 months, a figure that has remained stable for almost two decades. Migraines can be severely debilitating and are considered one of the main causes of disability worldwide. In one study among patients with migraines in the United States, more than half reported severe impairment in activity, the need for bed rest, and/or reduced work or school productivity due to migraines.
If you suffer from debilitating migraines, then you know how painful and limiting the neurological disorder can be. You’ve been forced to miss important events due to that pulsating pain and ever-present nausea. You’ve even had to adjust to lifestyle changes, making sure you get just enough sleep—not too little and not too much. You take the medicines regularly, both the preventative type and the kind that helps you deal with an attack. Yet you still don’t have a good handle on your disorder—the treatments aren’t helping as much as you need them too, and you’re rapidly losing the small amount of control you have. If this sounds like you, it might be a good idea to do some research about new migraine surgeries.
What is Migraine Surgery?
The goal of migraine surgery is to reduce or eliminate headache frequency, duration and pain. Migraines can be associated with compression and irritation of sensory nerves and vessels around your head. When these compression points are released during surgery, the severity of migraines may decrease or you may not experience further migraines.
Sites of nerve compression are also known as trigger points. You may have one or several trigger points depending on your symptoms. The most common and main trigger sites are frontal (pain above your eyes and/or your forehead), temporal (pain over your temples), rhinogenic (pain inside your nose that can extend to behind your eyes), occipital (pain on the back of your head that can radiate across your skull to your eyes or behind your eyes). You may also experience pain at less common sites around your head.
What Are the good Aspects or bad Aspects of Migraine Surgeries ?
Surgical decompression of the peripheral sensory nerves around the skull can have a beneficial effect on the frequency, severity and duration of the migraine headaches. Surgery is performed as an outpatient procedure under local or (usually) general anesthesia and usually takes one to two hours. Some patients have multiple migraine triggers and surgery may take longer if the trigger sites are on different areas of the head. Surgery is not on the brain and we do not remove or go through the skull bones.
What is the surgery’s success rate?
Most studies have shown success rates above 70 percent, with roughly one-third of the patients experiencing total relief of their migraines. When successful, patients report an improvement in migraine frequency, duration, intensity and in health-related quality-of-life.
Who is a candidate for migraine surgery?
- Patients who have been diagnosed with migraines by a neurologist (not all headaches are migraines)
- Patients with sites of nerve compression identifiable with a high degree of confidence
Several other factors are considered, including the efficacy (or failure) of medical treatment, side effects of medications and the severity of the migraines. Patients with a favorable response to Botox® or local anesthetic injections are generally good candidates for migraine surgery.
Will I experience side effects or have scars?
Most complications are minor and temporary, and will vary according to the specific surgery. Treatment of migraines around the eye might actually improve the appearance of the forehead by decreasing wrinkles and correcting sagging eyebrows. Complications include wound healing problems, nerve injuries, bleeding and failure of surgery to ameliorate the headaches.
Most of the incisions are well hidden, either in the scalp or in the upper eyelid.
How long is the recovery?
Slight bruising and swelling may occur, and typically resolves within two weeks. Most patients are able to return to their usual activities in the same time frame. Depending on the specific nerves targeted by surgery, patients might be asked to avoid strenuous exercise for up to three weeks.
What surgical techniques are used ?
Two surgical techniques used to treat migraines are receiving mixed reviews from doctors. Plastic surgeons who perform the procedures have reported favorable results for a majority of their patients. Headache specialists feel more research is needed.
One procedure, called nerve decompression, removes tissue that puts pressure on one or more peripheral sensory nerves in your head thought to be trigger points for migraines. The other, called neurectomy, cuts a nerve in your head identified as contributing to migraines. The nerves lie on the surface of your skull and aren’t part of your brain.
The procedures evolved as patients who received eyebrow and forehead lifts were reporting back to their plastic surgeons a decline in migraine headaches following the cosmetic surgery.
Before proceeding with surgery, plastic surgeons generally require that a neurologist confirm the diagnosis of migraine. An important diagnostic challenge is to identify which nerve or nerves are trigger points for the migraines. They could be in the temple, the front of the head or the back of the head.
Surgeons also assess what medications or other treatments you’ve tried and whether they have failed. If you have had a favorable response to Botox® or local anesthetic injections, you may be considered a good candidate for migraine surgery.
Cautions from Headache Specialists
Despite reported successes, many neurologists and headache specialists are reluctant to embrace these surgeries as part of the standard treatment for migraines. They want to see more study. And, the US Food and Drug Administration has not approved the procedures for migraine relief.
Richard Kim, MD, neurologist and headache specialist, Premier Health Clinical Neuroscience Institute, thinks that cutting or decompressing a nerve to “cure” migraines is too simplistic.
“Migraine is a genetic disorder. It’s not just a peripheral mechanism. The headache community thinks there’s not enough good data to know if these headache procedures are really effective or not.”
He cites an article on the Choosing Wisely website of the American Board of Internal Medicine Foundation (ABIM). In the 2013 article, the American Headache Society advises physicians: “Don’t recommend surgical deactivation of migraine trigger points outside of a clinical trial.”
Both Dr. Kim and the Headache Society are concerned that current evidence is based on small controlled trials and observation. They advocate for large multicenter, randomized, controlled trials with long-term follow-up to provide more definitive proof that these surgeries will have lasting benefit and not cause harmful side effects.
“The surgery may work, but good, quality, evidence-based research is not there. A lot of the studies on these procedures have been criticized for not carefully defining which patients would be appropriate for this. We also don’t know if patients continued with preventive medications, which would affect the results.”
What Happens if You Get Migraine Surgery ?
In 2003 and 2004, surprisingly positive side effects were discovered to a plastic surgery procedure, the forehead rejuvenation. Patients who’d had the operation, which includes cutting into muscle, reported that their migraines disappeared. Based on that finding, some medical professionals designed two surgical techniques that identify migraine trigger points and treat the headaches. Another type of migraine surgery involves cauterization of superficial blood vessels located in the scalp. Finally, one last type of procedure deals with the correction of a congenital heart defect.
Benefits of Migraine Surgery
Surgery is a good option for several types of patients. Those individuals who don’t respond well to medication, who encounter nasty side effects from their pills, or who prefer to not be on medication permanently are great candidates for surgery. Furthermore, one small study shows that over ninety percent of migraine sufferers who went under the knife saw a fifty percent reduction in their headaches, via intensity, duration, or occurrence. Thirty-five percent of that group reported the complete elimination of migraines altogether. That lead to lower medical costs and less sick days.
Risks of Migraine Surgery
Of course , no surgery is without risk. First of all, you are not guaranteed to experience any relief from migraines at all. Also, common side effects include discomfort at surgical site, temple hollowing, neck weakness, localized hair loss, and eyelid sagging. As with most surgeries, there is the rare possibility that you will not respond well to anesthesia, which can lead to death (though that is very rare). Other rare side effects include phlebitis leading to deep vein thrombosis or pulmonary embolus (blood clot in the lungs).
If you’re continuing to suffer from migraines without reprieve, or you just don’t want to have to take pills every day, do your research about newer migraine surgeries. Though they’re not right for everyone, only your doctor and you can make that decision.