Migraine surgery is intended to be a one-time procedure, with the goal of alleviating the need to use acute migraine medications and chronic prophylactic medications. More than one type of technique has been proposed with the goal of “deactivating trigger sites.” In other words, those procedures aim to release peripheral nerves in the head and neck that are believed to be compressed, triggering the migraines.
How It Works
Migraine surgery is based on the same principles as other interventional techniques used in migraine prevention. Injections of pain medications and muscle relaxers to the neck or head muscles are believed to alleviate muscle contraction and pain and to release nerve pressure. Botulinum toxin (Botox), a potent muscle paralytic, has also been used in migraine prevention.
There is only limited evidence that either nerve compression or muscle spasm are involved in migraines. Nevertheless, these techniques seem to be effective for some people, suggesting that there is still a lot that the medical community needs to learn about migraines.
Prior to surgery, you may receive treatment with botulinum toxin. Some surgeons use this as a way to pinpoint the right location for migraine surgery.
Plastic surgeons have observed that the surgical techniques used in migraine surgery are very similar to those used in facial cosmetic surgery. In fact, plastic surgeons suggest that procedures intended for rejuvenation of the face may reduce migraines as well.
Indications
In general, surgery is considered for people who have not improved with migraine medication or who experience intolerable side effects from such drugs.
There have been some attempts to identify factors that can be predictors of improvement with migraine surgery. Some healthcare providers suggest that people whose migraines improve in response to botulinum toxin injections may also improve with other procedures.
Nerve Decompression
Migraine surgery involves nerve decompression through subtotal resection (partial removal) or complete resection of specific muscles or adjacent anatomy. A blood vessel can compress a nerve, causing nerve sensitivity. In such instances, the blood vessel can be gently “moved” to alleviate the physical pressure. The surgery is achieved by transecting muscles or other structures that may be compressing the nerve.
Efficacy
There is growing evidence that migraine surgery may work for some people. A number of small research studies have shown that some participants with refractory migraines may experience a greater than 50% reduction in migraine frequency, with a decreased need for medication for at least a few years after surgery.
But one of the leading concerns in assessing these results is that migraine surgery is a type of procedure that is prone to inducing a placebo response. This refers to an improvement in symptoms from the inherent bias and psychological effect of undergoing treatment, rather than from the treatment itself.
Also, reports suggest that even among research participants who are carefully selected for surgery, the success rate is quite variable. So, it is quite possible that you might not experience any improvement in your migraines after having this procedure.
In addition, many of the studies have shown flaws in their design, prompting the American Headache Society to recommend against the use of migraine surgery outside of a clinical trial.
Side Effects
There are few side effects and adverse events reported with this type of surgery, but negative outcomes can occur. The most common side effects include nasal discharge, dryness of the nose, and scalp itching.
Complications including infection, weakness or paralysis of the muscles, or post-operative scarring may occur.
A Word From Verywell
Migraines, especially refractory migraines, can have a major impact on your quality of life. Surgery is a potential—but not yet proven—treatment option for migraine prevention. Be sure to talk with your healthcare provider about all of your migraine-prevention options (lifestyle strategies, complementary and alternative therapies, and medication) and whether or not participating in a trial where surgery is being studied as a treatment for chronic migraine may be right for you.
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