Surgeries for Migraine Relief: Are They Helpful?

Migraine is a condition characterized by intense headaches localized to one side of the head. It is a common condition occurring more often in women. Individuals who experience migraines also indicate sensitivity to light, sound, or strong smells during headache episodes, as well as nausea. Unfortunately, many individuals who suffer from migraine do not respond well to the treatment, meaning that it does not provide pain relief. In addition, medical professionals estimate that treatment-resistant migraines are quite common, appearing in approximately one-third of the cases. With these alarming rates, healthcare researchers are focusing on alternative pain relief strategies, including surgical procedures.

For some patients, migraines are triggered extracranially — outside of the skull and under the skin. In the late 1990s, Dr. Bahman Guyuron and his colleagues published a compelling article describing findings that some individuals who underwent forehead rejuvenation have reported a relief in migraine symptoms.

Forehead rejuvenation is a plastic surgery procedure that aims to aesthetically improve the appearance of the forehead, making it look smoother and more youthful. This has set off a new line of research into extracranial migraine triggers and surgical approaches for pain relief.

What is the migraine surgery?

Migraine surgery, suggested as far back as the early 2000s, is a new approach for treatment-resistant patients. However, migraine surgery is a highly-individualized procedure that needs to be discussed with a clinician. Doctors normally perform migraine surgery under general anesthesia for overall comfort, though some procedures can be done using local anesthesia.

The surgery aims to reduce or eliminate painful migraine headaches. However, sometimes the procedure only manages to reduce the frequency, intensity, or duration of episodes. Some research shows that trigger points cause some types of migraines. These headaches commonly occur because blood vessels or nerves around the head compress.

Doctors focus on the locations of painful triggers, intensity, and frequency of headaches to customize methods. For example, the procedure can involve bloodletting particular vessels to reduce the pressure or ligate it (limiting blood flow to a vessel). If, on the other hand, the target site involves nerves, the surgeon may decompress the nerves in the area — a far more common option. However, these are only two techniques, and other approaches exist. Therefore, for individualized recommendations, one should consult with their physician.

Migraine trigger points

Migraine sufferers may have one or several trigger points. Here is list of trigger points that can be targeted during the migraine surgery:

• Frontal. An area above the eyes and/or forehead;
• Temporal. An area on one or both sides of the head, known as the temples;
• Rhinogenic. An area inside the nose that can extend to behind the eyes;
• Occipital. An area at the back of the head, in this case, the pain starts there and often radiates across the skull to the eyes or behind the eyes.

Who’s eligible for the migraine surgery?

As mentioned before, the individual details need to be assessed by a physician to determine if a patient is eligible for migraine surgery. It could also be possible to address only one or two trigger points, but most likely not all. The general requirements for being eligible for a migraine surgery include, but are not limited to:

• A diagnosis from a neurologist for migraines or occipital neuralgia (not all headaches are migraines);
• The person suffers from treatment-resistant migraines, meaning they’ve tried other therapies (behavioral, medications) without success;
• The patient is in good general health.

Migraine surgery success rates

So far, the migraine surgery has proven to be a highly successful procedure. Even though the majority of published reports come from Guyuron and his colleagues, who first reported pain relief for migraine patients after a plastic surgery procedure, other clinicians have also described having success with these procedures.

The early reports indicated that, on average, patients’ migraine headaches were completely gone, or they experienced at least 50% relief in almost 90% of cases. Later studies noted that up to 35% of patients indicated that the migraines were eliminated, and slightly above 50% indicated that they experienced an improvement in their symptoms in the long term, specifically over a one-year follow-up.

There are cases where residual migraine symptoms are present after the procedure. The reasons for that may be different based on each case. For example, it might be that one or several of the trigger sites could not be surgically addressed. In some cases, unfortunately, the migraine symptoms remain unchanged. Clinical studies are currently investigating newly discovered trigger sites. Overall, migraine surgery seems to have promising potential for treating persistent migraines in individuals who do not respond to other treatment options.