Is Migraine Surgery Right for you?

The surgical procedure can vary depending on the patient’s trigger sites, and only the identified trigger sites (up to 4, but usually 2-3) are surgically addressed. The goal of the procedure is to eliminate triggering stimuli (muscle impingement or airway turbulence and vibration).

Generally, the operation will be done as an outpatient procedure under sedation or general anesthesia. Affected nerves are decompressed from enveloping muscle and wrapped with fatty (noncontracting) tissue. When performed on the brow, the surgery is similar to a cosmetic brow lift. In back of the neck, the greater occipital nerve is treated similarly through a hidden incision in the scalp. Nasal airway surgery is a variation of the commonly performed procedure for a deviated septum resulting in breathing difficulty. Incisions are small and hidden in the nose.

How Are Patients Selected?

Patients must be seen or have been seen within the last 5 years by a neurologist, and have a diagnosis of migraine disease or neuralgia to be evaluated (exceptions have been made anecdotally for Cluster Headache that responded to Botox). Depending on the character and location of the disease, in addition to physical and CT scan findings, we will determine which of the four currently known trigger sites will be evaluated. Three of these sites—brow, temple, and the back of the neck—can be evaluated with injections of Botox®. The fourth site is the nasal passage, and can be tested with nasal sprays, in addition to physical and x-ray findings. Arrangements can be made for undiagnosed or more atypical headache patients to first be seen by a Neurologist with whom Dr. Branch has worked closely.

Preparing Yourself for Surgery

How long is the selection process?

The initial visit is an evaluation for testing candidacy. Testing is usually done at the time of the initial visit. Once all the trigger sites are identified, outpatient surgery becomes an option. For those that have already had complete or near complete response to trigger point testing by another physician, surgery can often be arranged to occur the day following a confirmatory consultation with Dr. Branch.

How does Botox® affect migraine headaches?

Current theory holds that Botox® results in the temporary weakening of the muscles that impinge on the nerves. Some do believe the Botox® acts inside the nerves themselves. These nerve branches have been pinpointed as some of the trigger areas that cause migraine headaches.

How do I know if I am a candidate for surgical treatment?

Botox® has proven to be an extremely reliable prognosticator. Of the 60 to 80% of patients who respond favorably to the injection of Botox®, 90% of those benefit from migraine surgery.

What to Expect After?

What is recovery like?

Incisional tenderness and temporary numbness of forehead and scalp.
Forehead itchiness.

Common complaints after surgery:

The procedure is day surgery and patients can go home following the procedure. Patients are out of work for one to two weeks, typically. Exercise and lifting (more than the equivalent of a gallon of milk) is prohibited for these two weeks. Headaches are common during this time, which can be managed with appropriate pain medications.

Are there scars?

Yes, however, all are small and hidden in a crease or within the hair. Nasal airway incisions are inside the nose.

Can I have this skin or bags removed from my eyelids?

Yes, often upper eyelid cosmetic surgery can be combined with the surgery at a reduced cost.

When do I see Results?

Improvements usually begin two to four weeks post surgery.