Migraine Surgery Explained: Frequently Asked Questions
- Migraine surgery is generally classified as nerve decompression surgery, a procedure developed by Dr. Bahman Guyuron about two decades ago.
- The procedure requires a plastic surgeon to make a small incision on the face, neck or forehead in order to physically adjust migraine trigger points.
- Ideal candidates are migraine sufferers who respond favorably to Botox, but experience little or no relief following other non-surgical treatments.
There are few medical conditions as simultaneously frustrating and puzzling as the migraine. These aren’t everyday headaches; they’re much more painful, they last longer, and can be downright debilitating for chronic sufferers.
Various surgeries are available, almost all of which are performed on an outpatient basis and are considered safe. The most popular and promising migraine surgery technique involves tweaking the nerves and muscles to eliminate pressure points.
But is going under the knife an effective treatment option for chronic migraine sufferers? Let’s take a look.
What is migraine surgery?
When you hear the phrase “migraine surgery,” there’s a good chance that means nerve decompression surgery. This surgical treatment option requires the suppression of myofascial trigger points — the irritable spots that can become tight, triggering migraine pain — so that they are unable to send any pain signals to the brain.
The surgery was developed by plastic surgeon Bahman Guyuron, M.D. in the early 2000s. Dr. Guyuron observed that patients who suffered from chronic migraines (more than 15 per month for at least three months) reported significant relief after undergoing a brow lift and other cosmetic procedures. His subsequent research showed that migraine attacks are caused by inflamed nerve branches in the head and neck.
According to Dr. Guyuron’s research, the migraine trigger points become irritated when surrounding nerves experience excessive pressure. If these trigger sites can be pinpointed and treated through surgical intervention, patients can see significant improvement. Doctors isolate these points in various of ways, including via CT scan, nerve block and ultrasound Doppler.
How is migraine surgery done?
Migraine surgery is typically performed on an outpatient basis under general anesthesia by a board-certified plastic surgeon (more information on that below).
Surgical procedures vary based on our body’s specific trigger points. In many cases, it’s the interaction of the corrugator muscle and the trigeminal nerve that triggers migraines.
In such cases, a doctor will make a small incision along the eyelid crease to remove the pain triggering muscles. Most often, that includes removing the corrugator muscle and suppressing the supraorbital nerve or other sensory nerves that cause migraine pain. Keyhole surgery may also be used to relieve pressure, especially in trigger points in the neck.
Specific surgical techniques are used to target migraine headaches that occur at different trigger points, including around the forehead, temple, back of the head and behind the eyes. It typically takes plastic surgeons one to two hours to complete the procedure.
Does migraine surgery work?
This all sounds like amazing news for those who suffer from chronic migraines, but does it actually work? According to a study conducted by University Hospitals Case Medical Center in Cleveland, surgery patients who had migraine trigger surgery experienced lasting results, with nearly 90 percent of patients reporting at least partial migraine relief five years after the surgery.
The study, published in the American Society of Plastic Surgeons’ (ASPS) official medical journal, Plastic and Reconstructive Surgery, showed that about 30 percent of chronic migraine sufferers who had the procedure experienced a complete elimination of migraines.
Another study using data collected from Facebook group posts by people who had recently underwent the procedure found that nerve surgery had a higher success rate than other migraine treatments, and was recommended by 90 percent of users.
It’s also more effective when used to cure migraines in teens. Dr. Guyuron’s studies in the early 2000s concluded that a group of adolescent migraine sufferers saw a significant improvement — their frequency of migraine headaches decreased from 25 to five per month — after undergoing nerve decompression surgery.
Who performs migraine surgery?
It may seem curious that these types of surgical procedures are generally performed by plastic surgeons, since migraine surgery is not classified as a cosmetic procedure. This is in part because many of the field’s leading surgeons are trained under Dr. Guyuron, who is a plastic surgeon himself.
The procedure is also an adaptation of a cosmetic surgery procedure that was once regularly used to treat wrinkles. This is good news and bad news. On the positive side, it means that you’re less likely to experience any significant scarring or cosmetic issues when you undergo nerve block surgery. On the other hand, it may be harder for you to convince your insurance company to cover the procedure.
How much does migraine surgery cost?
In the United States, the cost of migraine surgery is around $5,000 per pain trigger point. On average, most people have six pain trigger points. That means that your surgery could set you back as much as $25,000 to $30,000.
With that being said, some doctors argue that the procedure actually costs patients less over the long term, because they make up for it by saving money on medications and missed time at work.
Does insurance cover migraine surgery?
Navigating insurance coverage in terms of migraine surgery and migraine treatments at large can be, well, a headache. Surgical procedures that do not require an implant of some sort typically do not require approval by the U.S. Federal Drug Administration (FDA), which makes them more difficult to get covered by insurance. However, there are some exceptions to the rule. The best course of action is to talk to your doctor and insurance provider about cost mitigation.
What are the different techniques and types of surgery?
As we know, most migraine surgeries target pressure points and nerves to relieve pain. Under this umbrella, there are various surgical techniques. Which type of surgery you have will come down to where your trigger points are located.
Minimally invasive supra-orbital nerve surgery, or M.I.S.O.N. surgery, is a version of the procedure designed to relieve pressure points caused by nerves in the forehead. Minimally invasive greater occipital nerve entrapment, or M.I.G.O.N.E. surgery, is a type of nerve decompression surgery that relieves pressure points and nerves in the back of the neck.
Another surgical procedure involves removing or compressing the zygomaticotemporal nerve, which is often to blame for temporal headaches.
Neurostimulation is yet another surgical method that has been used to treat spinal injuries, epilepsy and back pain. This option requires the implantation of electrodes beneath the skin to trick nerves to stop sending pain messages to the brain. For some patients, septoplasty — surgery to correct a deviated septum — can procure good results when nasal nerves trigger migraines.
Am I a good candidate for migraine surgery?
Although we know that migraine surgery can be a very effective treatment option for many chronic sufferers, it’s not the best choice for everyone.
Those who want to undergo nerve decompression surgery should meet the following criteria:
- You suffer from at least 15 migraine headaches per month due to nerve compression and feel pain, tightness and pressure during headaches.
- You have tried other non-surgical migraine treatments and have experienced little or no relief.
- You don’t respond well or cannot tolerate certain migraine medications.
- Your migraines are debilitating, and cause you to miss out on work, social events, exercise and other important parts of life.
What other treatments work?
If you’re nervous about going under the knife, don’t worry. Doctors continue to develop new migraine treatment options every single day.
Even the father of contemporary migraine surgery, Dr. Guyuron, recommends the use of Botox as an effective migraine relief option. In fact, many doctors recommend that patients try Botox for a period of several months before surgery (the FDA approved Botox for treating chronic migraines in 2010).
Although nerve decompression surgery is an outpatient procedure with few known risks, Botox is always a good choice for people who fear going under the knife. You may also consider other migraine treatments, such as nerve blocks. This outpatient procedure is performed under general anesthesia and requires the injection of pain medication directly into the nerves, effectively blocking pain.
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