Migraine Surgery — New Technique Developed for Chronic Sufferers

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
Plast Reconstr Surg. 2011;127:603-608. Abstract http://www.medscape.com/viewarticle/737101

Comments

View Comments (13)
  • jhallmd
    6 years ago

    This is a good summary of the 5 year outcomes study that has been done in Cleveland with respect to long term outcomes from migraine surgery. These same authors have also published their series of patients who underwent “sham” surgery and compared their results to those patients who underwent nerve decompressions. Not surprisingly, they found that the patients who had nerve decompressions had significantly better outcomes with respect to the intensity, duration, and frequency of their headaches than those who underwent “sham” surgery.
    What is notable is not only the results, but that the study was done at all. “Sham” surgery studies are extremely difficult to get approved, and very few surgical treatments have been subjected to this kind of academic rigor.
    If you are a chronic migraineur and have come to “the end of the line” from a medical standpoint, have your neurologist send you to a surgeon who is trained to perform these procedures to see if you may be a candidate. As you have read here, the results can be life-changing.

  • Nancy Guillott Stiefler
    7 years ago

    I had Greater and Lessor Occiptal Nerve Decompression surgery Nov 2010. Insurance would not pay, saying it was experimental surgery and not proven for migraines. It took about 14 months for the complete benefit to be achieved. I had an 85-90% decrease in migraines on the back of my head. I still get about 20-25 migraines a month, but almost all are on the front and sides of my head. My surgeon, Dr Carlton Perry in Houston, does the surgery for a flat $15K if insurance will not pay. I thank God for Dr Perry and Dr Pamela Blake, my Neurologist/Headache Specialist.
    I am currently trying to get insurance to pay for the second surgery on my forehead, temples, sides of my head, etc. The have denied payment and Dr Perry has appealed. As soon as we have a final decision, I’ll be scheduling my surgery. I can’t wait. I started out with a migraine every day and ANY reduction is an improvement! If you suffer from more than 15 migraines a month, it’s worth looking into the surgery to see if you’re a candidate.

  • Shannon Stroman
    7 years ago

    I just met someone that had this done 10 yrs ago and swears by it! It was an accidental perk actually. She went in for the forehead lift and came out with minimal migraines after! She said it changed her life completely!

  • Christina Gessler
    7 years ago

    How do you get insurance to cover it? Are there any clinical trials?

  • Shannon Stroman
    7 years ago

    I understand that some insurances will cover it as long as you go through all their hoops first. Take all the medications, do a migraine journal, and you have to do the botox to identify the correct muscles to target in the surgery. That could take a year before the surgery is approved from my understanding. Talk to your neurologist or even just set up a consult with a Migraine Surgeon in your area.
    http://themigrainesurgery.com/

  • Catherine Friemel Kennedy
    7 years ago

    Botox works great for me! I love it. It has reduced the number of my migraines significantly.

  • Tammy Osborne Doane
    7 years ago

    I’m a candidate as well suffering with weekly attacks lasting from 1 to 5 days. I can’t imagine what life would be like without migraines.

  • Shannon Stroman
    7 years ago

    What do you have to do to get approved for the procedure??

  • Tammy Elder Rome
    7 years ago

    I’m a candidate and going for it. I’ve got nothing to lose. Will keep everyone posted on how it goes. First round of Botox is Feb. 21st. Currently averaging 17 migraine attacks each month.

  • Shannon Stroman
    7 years ago

    Hey Tammie! What’s the word on getting approved for this procedure? I feel you on the frequency. I just had my first round of botox last week. No results yet. How did your first round go?

  • Julie Lyon
    7 years ago

    Interesting article!

  • Lynette Satterfield Blackwell
    7 years ago

    Migraine free! That would be a dream come true!

  • madlibrarian
    8 years ago

    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.

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