Is migraine surgery a cure for extreme headaches?
In a randomized clinical trial research published in 2008, 84 percent of patients with migraine headaches had a significant improvement (50 percent or more) after the surgery, while 57 percent of patients had a complete resolution of chronic headaches after the surgery.
What are migraine trigger sites?
Most sufferers of migraine headaches experience similar patterns associated with each attack. For example, one may experience a dull pain behind their right eye, whereas another individual feels the onset of the headache in the left temple at the start of the headache. Although the symptoms vary among individuals, each person usually has a unique presentation pattern.
Trigger sites are specific locations where a patient feels their headache start. The presentation can vary from dull twitches and irritable areas to sharp pain in the head or neck. Recent studies have shown that these trigger points correspond to areas of muscle tightness in close proximity to the nerves.
Common trigger points have been identified in migraine sufferers for targeting migraine management. These trigger points include:
- Areas above the eyes (forehead area)
- Behind the nose and between the eyes
- Back of head (occipital area)
In migraine surgery, we identify the major and minor trigger sites in each patient and address them individually by releasing the involved nerves.
How can my plastic surgeon identify migraine trigger sites?
The presentation of migraines is different depending on the trigger points. Therefore, identifying the trigger points is crucial in treating the migraine sufferer. Based on specific questions and descriptions of your associated symptoms, your plastic surgeon surmises where the culprit trigger points are.
Another technique to identify the trigger points for migraine surgery is the use of neuromodulators such as Botox® or Dysport®. We weaken the muscles around the trigger point which leads to significant improvement or resolution of the symptoms. This approach has two goals: first, it helps to confirm the trigger point location and its contribution to the headache; second, it provides significant relief of symptoms for a few months for the patient. The procedure is repeated as symptoms recur.
If you happen to have a headache attack while at your plastic surgeon’s office, he can inject the area of pain with a numbing injection (similar to what you receive at the dentist office). When the correct nerve is anesthetized, you should feel an immediate relief of your headache. This is another way of confirming the culprit trigger points in migraine surgery.
What is the role of Botox® in migraine headaches?
For most patients who suffer from migraine headaches, there are one to three trigger points for the onset of a headache. Research studies have identified muscle tightness and direct pressure on the sensory nerves as one of the causes of migraines.
Using neuromodulators such as Botox® or Dysport®, your plastic surgeon weakens the muscles around the trigger point which leads to significant improvement or resolution of your symptoms. This approach has two goals: first, it helps to confirm the trigger point location and its contribution to the headache; second, it provides significant relief of symptoms for a few months for the patient. The procedure is repeated as symptoms recur.
Does Botox® treatment for migraine headache also help wrinkles in my face?
This is a very common question. The purpose of Botox® or Dysport® for migraine headache is to relieve headache symptoms, not smooth wrinkles. However, some of the muscles that we address by injecting the Botox® might also be responsible for specific wrinkles in your forehead or face. In this case, a neuromodulator injection will help to smooth out some wrinkles in addition to targeting headache symptoms. So in short, the answer is ‘Yes.’
Am I a candidate for migraine headache surgery?
To qualify for surgery, we have to determine that you will benefit from it. Initially, Dr. Abolmaali communicates with your neurologist to confirm your migraine headache diagnosis. There are many other types of headache which may mimic a migraine, but are not treated with surgery.
During your first consult session, you are thoroughly examined and a full medical history is obtained. You are asked to fill out a questionnaire to evaluate the severity of your symptoms thereby guiding the treatment and leading to its success.
In preparation for surgery, Dr. Abolmaali works with you to correctly identify the trigger sites responsible for your headache. This preparation stage includes consult sessions for the methodical injection of trigger sites with Botox® or Dysport® to identify each trigger point. This significantly contributes to the success of surgery.
If you happen to have a headache attack while at your plastic surgeon’s office, he can inject the area of pain with a numbing injection (similar to what you receive for sutures). When the correct nerve is anesthetized, you should feel an immediate relief of your headache. This is another way of confirming the culprit trigger points in migraine surgery.
What is migraine headache surgery?
Migraine headache surgery is a broad group of procedures targeted at specific trigger points causing the headache. The goal of surgery is to decompress the tight muscle around the nerve. There are four major trigger areas as well as a few minor ones. Each trigger point warrants a completely different surgery. Experience and a complete understanding of the anatomy of nerves and muscles in the head and neck enables your plastic surgeon to decompress the precise nerves associated with your trigger points.
Surgeries can be performed open or endoscopically. Endoscopic nerve release for migraine headache is a minimally invasive procedure to decompress the nerve and is performed through tiny incisions using small cameras and special instruments. If the trigger point is located in or under the nose, then an open or closed rhinoplasty (nose job) may be needed to access the associated nerve.
Does my health insurance cover Botox® or Dysport® for migraines? Does it cover the surgery?
Use of neuromodulators (e.g. Botox® or Dysport®) has been approved by FDA for the management of migraine headaches and most health insurance carriers cover the cost of injections as well as surgical intervention.
Your insurance carrier requires a clear history of your receiving different medical treatments for migraine headaches and a referral by your neurologist.