Septoplasty

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  • #46859

    Rachel P
    Participant

    I recently found that I have a deviated septum that is very likely causing most of my migraines. After visiting and consulting with an ENT, he has suggested a septoplasty and turbinectomy to fix my septum and reduce the size of any overgrown nasal turbines.
    I am seriously considering the surgery and have a lot of information about what the surgery and recovery will entail.
    I wonder if anyone has ever had this surgery or knows anyone who has (whether for migraine relief or just to fix a deviated septum). I’ve read a lot about things, but I know it’s not the same as first person experiential information. I appreciate any and all information that anyone has!

    – Rachel

  • #46887

    Teri Robert
    Participant

    Rachel,

    Who told you that the deviated septum is “causing most of your Migraines?” There is no evidence of this in any of the Migraine medical literature.

    I can share my personal experience with you. I had both the septoplasty and trimming of the turbinates some years ago. I’m glad I did because the surgery put a stop to the nearly constant sinus infections I was having. However, it made no difference at all to my Migraines.

    Keep us posted?
    Teri

  • #46899

    Rachel P
    Participant

    Teri,

    I was told this by my ENT. I am also very prone to sinus infections, so he said that this may help to alleviate them as well.
    I had been looking for literature about this idea of the septum somehow being connected to my migraines, but couldn’t find any. He had me using an anti inflammatory nasal spray when I felt the beginnings of a migraine, and in most cases, it was enough to quell the migraine from fully developing.
    Apparently, the lining in the nasal cavity swells during changes in barometric pressure and hormone level changes, and I am prone to migraines during both of these times. I of course have other triggers, but these were two that I have never had any control of.
    Thank you for sharing your story with me, and I will be sure to keep you posted as this all unfolds!
    -Rachel

  • #46901

    Teri Robert
    Participant

    Rachel,

    Thanks for the reply and info. I’ve searched medical literature, and can’t find anything about this type of surgery helping with Migraine.

    Migraine experts don’t know the mechanism by which barometric pressure changes trigger a Migraine. Most of them think it probably has something to do with the impact on cerebrospinal fluid pressure. Certainly, increased CSF pressure can be a Migraine trigger, That’s readily evidenced by the fact that idiopathic intracranial hypertension, a condition in which the CSF pressure is elevated, is a huge trigger for some of us. I’ve never heard the theory about the inflamed nasal cavity before.

    You’re so right that barometric pressure and hormonal changes are very difficult triggers to control. I get a Migraine every time I fly and am likely to get one with weather changes. One thing I have found with the weather changes is that when I have a preventive regimen that’s working well, it helps with Migraines from that trigger too.

    This is an interesting conversation. Will watch for your updates.

    Teri

  • #47639

    nancym
    Participant

    Hi Rachel,

    I just now saw your post – sorry I didn’t see it sooner! I also had a septoplasty/turbinectomy surgery to hopefully reduce my headaches. Before going into surgery, my ENT said it wasn’t likely that the surgery would make the headaches stop. He was right about that. However, I was so happy that I did the procedure as I had completely forgotten what it was like to breathe easily through my nose.

    I have headaches pretty much daily and when the weather/barometric pressure changes I am a mess.

    I guess what I am trying to say is don’t get your hopes up for this being a migraine solution, but I highly recommend the surgery in order to get the blockage cleared so you can breathe.

    Good luck and I am interested in hearing what you decide to do.

    Nancy

  • #47712

    Becky
    Participant

    I had my deviated septum repaired in 1998, it didn’t help migraines and I never expected it to. But along with taking Mucinex for the rest of my life it has def helped the sinus infections and now I can breath on both sides.

  • #48089

    Brian in TN
    Participant

    Hi Rachel,
    Sorry but my septoplasty / turbinectomy in ’97 had basically the same results, much better breathing, especially at night, but no effect on my headaches. I have heard of a new procedure that supposedly shrinks the turbinates permanently without surgery but I don’t know anyone who has had it. I know removing the packing ( tampons) was definitely the worst part of the process so it bears investigation. Of course I was in the Navy when this was performed at a Navy hospital so a civilian procedure could be far less unpleasant. Hope this helps.
    Brian
    P.S. How sure are you those were sinus headaches? I’ve come to the conclusion that most of my “sinus headaches” were actually migraines.

  • #50647

    JLampertMD
    Participant

    Headaches are not typically cured with septoplasty, though there has been some significant study in the area – specifically regarding migraines. Dr Guyuron, in Cleveland, has published and presented on the topic extensively. Paranasal headaches, or migraine headaches with a “nasal trigger point” may involve intranasal abnormalities which, in theory, may irritate the end branches of the trigeminal nerve. Surgical treatment of migraines has been proposed by using septoplasty and turbinectomy.

    I still do not feel that septoplasty is widely practiced as a migraine treatment, but it is an interesting subject which requires further exploration. I personally have had patients with forehead trigger points who have improved with botox or dysport treatment to the frontalis muscle. The citations of some interesting article are included below.

    Hope this helps!

    Guyuron B, Reed D, Kriegler JS et al. A placebo-controlled surgical trial of the treatment of migraine headaches. Plast Reconstr Surg 2009; 124(2):461-8.
    Liu MT, Armijo BS, Guyuron B. A comparison of outcome of surgical treatment of migraine headaches using a constellation of symptoms versus botulinum toxin type A to identify the trigger sites. Plast Reconstr Surg 2012; 129(2):413-9.
    Guyuron B, Kriegler JS, Davis J et al. Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg 2005; 115(1):1-9.
    Guyuron B, Kriegler JS, Davis J et al. Five-year outcome of surgical treatment of migraine headaches. Plast Reconstr Surg 2011; 127(2):603-8.

  • #61554

    Rachel P
    Participant

    Thanks all for the responses. I still haven’t had the surgery, and have realized that if I do, it would be to ease my sinus infections more than anything else. Thank you all for sharing your stories with me!

    – Rachel

  • #72179

    Kim Hamilton
    Participant

    I had migraines for 41 years. I just had a successful specialized septoplasty by Dr. Kevin Smith in Houston, Texas. He specializes in migraines; 90% of his patients get migraine relief. He is an ENT and a plastic surgeon. I also had a deviated septum. I had no history of injury but all the classic symptoms of migraines. I usually had 3-4 per week; self injected using triptan type drugs for relief. If your migraines start in your nose, please don’t waste those good years like I did, please get help.

  • #72305

    Katie M. Golden
    Moderator

    Kim,
    Thanks for sharing your story. I would always suggest getting a second opinion for any type of surgery. If it worked for you, I’m so glad it helped! It is often undiagnosed that sinus headaches are actually Migraines. But genuine sinus issues can relieve Migraines. Thanks for sharing!
    -Katie
    Migraine.com Moderator

  • #72476

    Kim Hamilton
    Participant

    Yes it worked for me. It has been nothing short of miracle since I am absolutely migraine free. We and physicians are taught that migraines have a neurological origin. Dr. Smith is the first doctor I have seen that looked for a physical cause for my migraines. The cure was a day surgery which my insurance covered. See this link to here more of my story on The Doctors TV Show:

    http://www.thedoctorstv.com/episodes/pain-cure-through-your-nose-baby-attached-to-placenta-for-6-days-a-superfood-donut#

  • #80255

    SJD
    Participant

    I do believe Kim Hamilton’s story. I saw her on the doctor’s program with Dr. Smith. I’m wondering if other ENT’s can do the same surgery? I can’t go to Houston. I’m also wondering how painful it was when they ripped out the cotton packing with all the dry blood and nose hair stuck to it.

    I’m really concerned that not many ENT’s and other nose surgery experts don’t seem to mention the correlation between migraine and a deviated septum. Why would only Dr. Smith get these results?

    As you can see I’m somewhat cynical and am very afraid of a painful surgery.

    I am not doubting Kim Hamilton’s experience at all. I don’t understand why people would need to travel to Houston when there are lots of board certified ENT and facial plastic surgeons all over the county.

    I appreciate any feed back. I am very glad Kim got her life back!

  • #80327

    Kim Hamilton
    Participant

    Thank you for your post. I understand your concerns. I had been diagnosed with deviated septum by numerous ENT’s over the 41 years. Yet, all of them told me that they were not causing my migraines. In all of those years I heard about septoplasty from one doctor.

    I had asked my current primary care physician about other alternatives (always looking for something new I had not heard about). She did mention septoplasty but said it was highly controversial. I googled it and then I understood why. Many ENT’s can do sinus surgeries and afterward people have migraines. It’s a scary thought because those who have migraines are very, very protective of those things that could make them worse. If you go to http://www.kevinsmithmd.com he and I did a follow up on the surgery to let people know what to expect and he explains more in detail his procedure. He never packs a nose unless it is necessary; he discusses that. Mine was not packed. I had a little gauze under my nose across my nostrils for about three days. It felt like a bad cold with a lot of drainage. The pain was very manageable. The hardest part is you need to sleep setting up, in my case, for about 10 days. My surgery was February 8, 2016. I have not had a migraine since that day. Also, you don’t have to go to Houston for a diagnoses. Dr. Smith requests you provide him a specific set of CT scans of the sinuses. I believe mine were $400 but insurance paid for all but $200. You send those to him on a CD (no paper reports). He can look at those and he said it is either a yes or no answer. I almost did not get the surgery either. I even told Dr. Smith that he had selected the wrong person for the TV show. Nothing worked for me ever. He assured me that it was going to be much better. It hasn’t been better; it has been absolutely the greatest gift of my lifetime. I welcome you to contact me with any questions you may have no matter how trivial. I did ask Dr. Smith about what is different about his technique. He has perfected it over 20 years. He actually sees a lot of patients that have botched sinus surgeries. Go to his web site if you have a few minutes. Hopefully you will see more answers there. He actually would love to give up facial plastic surgery and just do migraine surgeries. He is really passionate about it.

  • #83699

    stormka
    Participant

    Hi Rachel,

    It looks like a lot of folks are trying to talk you out of this! I have a positive comment.

    I recently visited with Dr. Portuese (the best ENT and plastic surgeon I could find) in Washington state about my sinus issues. I have a huge bone spur and allergies that I need tending to. As a side note he said that there was a 60% chance that the procedure to correct the aforementioned would also rectify my migraine issues.

    I would seek a second or third opinion offline. Perhaps someone with good credentials. Not that a forum isn’t a good place to start but I wouldn’t discount some initial good news.

    Good luck!

    -K

  • #88625

    Allison
    Participant

    I have a friend whose daughter’s migraines were relieved by Dr. Smith’s surgery so I went for a consult. I did not like his bedside manner and had difficulty getting questions answered during and after my visit. I went back to my ENT at home who evaluated me and performed the exact same surgery Dr. Smith was suggesting. He did not over promise a “cure” as Dr. Smith did as my headaches are multifactorial. I did get quite a bit of relief. Two years later I did have to repeat the sinuplasty because he (and Dr. Smith) did not include addressing the underlying allergies in their treatment plan. My current ENT did that procedure in his office with an easy recovery and I’m on allergy drops and nasal spray to hopefully not have problems again. I had no idea until the CT scans that I get chronic sinus infections and that is ONE thing causing headaches. I would suggest this if you have sinus issues but be realistic.

  • #90986

    pj2359
    Participant

    Just wondering Kim iHamilton f you are still headache free. My husband has a deviated septum and severe headaches. Considering this surgery. So glad you are feeling well. Praying it goes the same for my husband.

  • #99286

    celloandpiano
    Participant

    Thank God for this thread. Just read all the posts, and joined the forum. I have had migraines, right side primarily as well as left side, for over 30 years. When a friend recommended I get examined for the possibility of deviated septum w bone spur as a cause, I both did so and then consulted via email with Dr. Kevin Smith’s office in Houston. The friend’s mother had been operated on by Smith, and claimed 100% relief, at the time.

    Long story short (well, okay, long story): Dr. Kurt Steehler examined me, confirmed deviated septum w spur in my left nostril, and said he could perform corrective surgery without guarantee that migraines would cease. He also asked me to get Dr. Kevin Smith’s office to consult with him re the specifics of the surgical procedure used claiming relief from the headaches.

    Instead of doing so, I consulted directly via email w Smith;s office, filled out the applications, had the CT scan of maxilofacial sinuses, sent it to his office, and was scheduled for surgery on a specific date by his office after he spoke directly with me by phone confirming me as a “great candidate” for the procedure.

    Following my acceptance of the date sent to me by his office via email, I reserved a flight to Houston for myself and another person who agreed to go and be my post-surgical caregiver.

    I also followed up by inquiring via email both regarding my low blood pressure concerns per anesthesia, as well as the forms attached via email which my PCP’s office could not access and which were required pre-op as physician confirmations. The email replies were not adequate in addressing either of my concerns as expressed, and phone call attempts to get help were both cut off and.or not addressed.

    At that point, I rec’d an email informing me that my concerns had been forwarded to their office manager, by name. Up until that point, I had neither heard of said office manager nor been told of any office manager; rather, all my correspondences had been addressed by two women who worked in the front office.

    When I spoke with said office manager by phone, she first asked me if I had paid for my flight to Houston. I said yes. She then said that, due to my concerns as expressed, my surgery would have to take place at a Houston surgery center (whose name escaped her at the moment but that it was located nearby) rather than their office, and that the date of my surgery would need to be moved two days out. I exclaimed that this was my return flight date (Dr Smith had told me that, due to my being an out of town patient and the fact that my post op caregiver was a registered nurse, he would be able to allow me to return home earlier than the otherwise recommended three full post op days) – and, asked if their office would re-imburse me my flight expenses should I need to change the itinerary. My questions were not answered as posed. When I asked said office manager if she were an attorney, she answered neither yes nor no – leading me to believe, by such behavior from her, that she might very well be an attorney. But, rather, she called my question inappropriate.

    At that point, due to her also having said that she would contact the surgery center about getting me scheduled very early on my original surgery date and that the surgery center would follow up with me exclusively thereafter by phone, I told her that I would end our phone conversation so that she could get on that right away.

    And, then, I waited. The surgery center did not call me. My window for changing my flight itinerary was closing. I paid for flight insurance, errantly thinking this would protect me from financial penalty (it didn’t) were I to change my flight dates. Within the next 36 hours, I placed phone calls to Smith’s office in an attempt to find out if the surgery center had gotten back with them about my surgery schedule.

    Finally, I received a phone message from the office manager, as well as an email containing and attachment.
    When I opened the attachment and read it, I was shocked; their office, according to the office manager, was declaring that I could no longer be considered as a candidate for Dr. Smith’s surgery, due to their claims of my treatment toward the office personnel by phone and email. She also stated that they could not be responsible for any reimbursement of costs incurred by me, to date, per my flight reservations. I could NOT believe it.

    My registered nurse and I decided that we should go ahead and fly to Houston – since a.) we could not get our money back for the tickets, and b.) we might as well make a 2.5 day vacation trip out of it, since he’d already taken two vacation days and paid the dog sitter.

    When we got to Houston, we paid Dr. Smith’s office a visit. I asked the nurse who traveled with me to try to meet directly with Dr. Smith. He had to fill out a patient intake form, which appeared disingenuous but our only recourse. When we finally were called back into the office, the doctor did not enter the room; the office manager came in, instead. When we revealed who I was, she said she was sorry but that their office could not treat me or operate on me. We tried to ask why, and were told that I was “too unpredictable” and might question them post-surgery. All verbal attempts to persuade them otherwise failed.

    We were given my CT scan back to take home with us, and we left the office.

    I waited several months. About three months ago, I attempted to reach the doctor directly by mailing a packet to him via the surgical center which was to have scheduled me for surgery. I also called the center, and spoke with a woman who said she would hand the packet directly to Dr. Smith the next time she saw him in the office. I also called back to confirm her receipt of it, and she said she had retained it and would follow through. I heard nothing from Dr. Smith, thereafter.

    About two weeks ago, I sent the office manager a letter, asking her directly to be re-considered as a candidate. I heard nothing, from her. Today, I called the office, and spoke directly with her – again, asking to be reconsidered. She, again, said that she could not honor my request, wishing me luck getting relief from my migraines.

    I hold absolutely NOTHING against Dr. Kevin Smith. I still believe he holds the surgical key to correcting the cause of my migraines. 30 years ago, the bridge of my nose hit the steering wheel in an auto accident in which I was hit broadside, after which my migraines commenced bi-monthly. They continue to this day. Orthodontia is in process, addressing TMJ on the right side, but the left side headaches continue.

    I would, however, warn anybody considering contacting his office. PLEASE get everything in writing, and save it all to print. PLEASE try to communicate directly with Dr. Smith, himself, at every opportunity; I believe contact with him is the key to avoiding the disastrous and profoundly disappointing experience which I just outlined for you all.

    Thank you for reading this, friends. Here’s to a life free of migraines!!

    • #99321

      SJD
      Participant

      Regarding cellandpiano’s issue with the doctor…. He is not the only doctor who can perform that type of surgery. If you live near a metropolitan area you will find ear nose and throat surgeons who can perform this surgery.

      If you find another doctor, I wouldn’t tell them anything about seeing the doctor in Houston. Once one doctor hears another won’t touch you due to possibly being sued, the new doctor probably won’t touch you either.

      Just pay for new x-rays with the new doctor unless you have kept copies of the x-rays you had earlier. Don’t have the Houston doctor transfer those x-rays to the new doctor.

      Also, once a doctor has decided you are a person who might sue him no matter how many times you call or go in person to plead for the surgery the doctor won’t touch you. When you asked the lady on the phone from the doctor’s office if she was a lawyer (She may have been), you really freaked them out.

      I learned all this when I had a surgeon who had a terrible and rude bed-side- manner and switched to a different doctor because of that. The rude surgeon did a good job as far as treating me it’s just that he was so rude and demeaning I wanted a different doctor in the future.

      When I told the new surgeon how I was treated badly by the previous surgeon I could see the new surgeon tense up. When I explained that the previous surgeon’s medical treatment of me was excellent, it was his bed-side-rudeness that I didn’t like he relaxed.

      I had the feeling that if I had not made the new doctor understand that it was just the bed-side-manner I objected to he would not have taken me as a patient.

      Find a new surgeon who does this procedure. This doctor in Houston is not the only person in the country who does it though they possibly might like you to think so.

      Good luck to you and all migraine sufferers.

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