Migraine Surgery

Migraine Surgery

The Division of Plastic, Aesthetic and Reconstructive Surgery of the DeWitt Daughtry Family Department of Surgery at the Miller School of Medicine – University of Miami is now offering surgery for the treatment of migraine headaches to those individuals whose migraine headaches have not responded to medication or other forms of treatment.

Impact of Migraine Headaches

Migraine headaches affect 18% of women and 6% of men and result in an estimated $1 billion in medical costs and $16 billion productivity loss in the USA annually. In addition, migraine headaches are the 12th leading cause of disability among women worldwide. A vast array of medicines are available, but none of these provide lasting relief. Unfortunately, many long-suffering patients are not aware that a reliable surgical option exists which may provide long term relief.

Who qualifies for migraine surgery?

  • You should be diagnosed with migraine headaches by a neurologist
  • You should have attempted non-surgical treatment with medications, with no success
  • You will likely have better results from surgery if there are identifiable areas where the headache starts (but may progress to involve the entire head)
  • If you have been diagnosed with occipital neuralgia or have a constant headache in the back of your neck resulting from a previous trauma or accident, you may also benefit from surgery

Four Main Trigger Sites

If you have pain starting from one of the locations below, it is likely that you will benefit from surgery. The most common trigger sites include the following:

  • Forehead trigger site. The pain is localized to the region around the eyebrows. Here prominent muscles involved in frowning compress two small nerves (supraorbital and supratrochlear nerves) on each side. Surgery involves removal of these muscles with the aid of an endoscope, through small incisions hidden in the hairline; or alternatively through an upper eyelid incision.
  • Temple trigger site. The pain is localized to the region in the temples. Surgery involves removal of a small branch of the trigeminal nerve which provides sensation to this area. This is typically done through an endoscope, with small incisions hidden in the hairline. This nerve is removed routinely during the course of forehead rejuvenation surgery.
  • Nasal trigger site. You may experience pain starting behind the eyes, worse in the morning. A deviated septum and enlarged turbinates, which are projections inside the nose, may touch each other, giving rise to migraine headaches. Surgery involves straightening the septum and reducing the size of the turbinates, performed through incisions hidden inside the nose. After this surgery, you may also experience an improvement in breathing.
  • Back of the head. The pain is localized to the back of the head. Here the greater occipital nerve may be compressed by muscles or vessels. Surgery involves decompressing the nerve through a small incision in the midline of the neck, above the hairline.

What should I expect during my visit?

You will be asked questions about the location of your headaches. You may also be given an injection of local anesthetic to test if your headaches respond to temporary blockade of a specific trigger site. You may also be a candidate for Botox injections.

About Surgery for Migraine Headaches

Surgery for migraine headaches aims to decompress peripheral nerves in the head and neck, which act as trigger points to induce a headache. These trigger points most commonly manifest as headaches starting above your eyebrows, at your temples, behind your eyes or at the back of your neck. These headaches may subsequently spread to involve the entire head. Surgery is performed as an outpatient procedure under general anesthesia. Incisions are hidden in the scalp, eyelid or back of the neck, and follow plastic surgery principles to ensure that scars are well hidden.

Recovery After Surgery

You may have swelling in the area of surgery that is particularly noticeable within the first week after surgery. You will be able to perform light activities, but should avoid strenous exercise, and should be able to return to work around 2 weeks after surgery or before.

Outcomes of Surgery

Studies have shown response rates ranging from 65 to 95 percent after surgery. Many patients have reported a dramatically improved quality of life, and the ability to do things they were never able to do due to debilitating headaches.