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Migraine Surgery – New Technique Developed for Chronic Sufferers
March 3rd, 2011 - Posted by Lisa Erwin
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A recent study in the journal Plastic and Reconstructive Surgery describes a procedure which targets ‘deactivation’ of migraine trigger sites for certain people who experience migraine headache. The goal of the surgery is to reduce the frequency, duration, and intensity of migraine pain. The senior author, a noted plastic surgeon, developed the techniques after noticing that some of his patients had fewer headaches after they had forehead-lift procedures for cosmetic purposes.
In the study, the authors report 5-year outcomes for a group of patients with migraine diagnosis confirmed by a neurologist, who underwent surgical deactivation of 1 to 4 common trigger sites. Before surgery, each patient was tested with botulinum toxin A (Botox) to confirm the correct trigger sites. For most patients, surgery targeted at least two sites that were thought to be triggering their migraine. For example, for patients with frontal migraine headaches starting in the forehead, the muscles in that area were removed, as in forehead-lift surgery. The five-year results were evaluated in 69 patients.
Patients Reported Positive Outcomes 5 Years Later
At various points in time, including pre-surgery, and 1 and 5 years after treatment, patients were surveyed on standard measures of migraine-related pain, disability, and quality of life. 5 years after surgery, 61 of 69 surgery patients (88%) had benefits from surgery and have maintained overall improvement, the researchers report. A positive response was defined as at least a 50% improvement in frequency, intensity, or duration of migraine compared with the same measures before the surgery was performed. Adverse events include occasional itching and hair thinning at the surgery site, increased or decreased sensation, numbness, stiffness and weakness. In general, the surgery was well tolerated.
Other results included:
- Complete elimination of migraine headache – Twenty patients (29%)
- Significant decrease in migraine headache – Forty one patients (59%)
- No significant changes – Eight patients (12%)
- Overall frequency of migraine attacks – decreased from about 11 to about 4 per month
- Average length of each migraine attack – decreased from about 1.4 to 0.42 days
Is Migraine Surgery For You?
In their paper, the authors acknowledge the possibility of the positive results being related to a “placebo effect”, as is common in many migraine and other pain related studies. Further, it is not known whether or not the migraine syndrome would have spontaneously resolved during the 5-year period of study nor is it exactly known how the procedure actually produces the desired effect. While it is clear that further study is necessary, migraine surgery may offer a viable option for people with chronic migraine who may have exhausted other available medical and non-medical options.
Plast Reconstr Surg. 2011;127:603-608. Abstract
http://www.medscape.com/viewarticle/737101
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"I had my first migraine when I was 12. I thought I was going blind, the spots in my vision all grouped together and everything went black. The pain was intense and felt like my head would crack open above my right eye." 
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I had surgery at the occipital trigger site in January and am seeing improvements in my headaches similar to what I gained from monthly nerve blocks at the same site — a reduction from more than 20 migraines a month to 10 to 12 now. The migraines I do have are generally less intense and more responsive to medication, although I do occasionally have one that sends me to bed still.
My surgeon and neurologist say it will be another six weeks before my new headache pattern is established, so I could see further improvements in that time.
I have Anthem BCBS, which declined Botox on first request and appeals. It paid a portion of the cost of the surgery, per my plan guidelines. I think it’s ridiculous that they are willing to pay out thousands for surgery that is still largely experimental but won’t pay for a round of FDA approved (and significantly less expensive) shots.