Migraine Surgery Options

These may be considered when other treatments have been unsuccessful

In This Article

Surgical treatment has been used as a strategy for migraine prevention. While it may work for some people, surgery is not the right treatment for everyone, and there are no reliable criteria to predict whether you will have a good response to such a procedure. That said, there is some evidence suggesting that surgery may be beneficial for people with intractable or refractory migraines (those that do not improve with medical or alternative treatment).

Migraine surgery is intended to be a one-time procedure, with the goal of alleviating the need to use acute migraine medications and chronic prophylactic medications. More than one type of technique has been proposed with the goal of “deactivating trigger sites.” In other words, those procedures aim to release peripheral nerves in the head and neck that are believed to be compressed, triggering the migraines. 

How It Works

Migraine surgery is based on the same principles as other interventional techniques used in migraine prevention: Injection of pain medications and muscle relaxers to the neck or head muscles are believed to alleviate muscle contraction and pain and to release nerve pressure. Botulinum toxin (Botox), a potent muscle paralytic, has also been used in migraine prevention.

There is limited evidence verifying that nerve compression or muscle spasm are involved in migraines, but, nevertheless these techniques seem to be effective in some patients, suggesting that there is still a lot that the medical community needs to learn about migraines.

The theory behind migraine surgery is that if botulinum toxin can temporarily prevent migraines by transiently decompressing nerves through muscle relaxation, then surgical removal of the offending muscles would mimic these effects permanently—or at least for a longer period of time.

Prior to surgery, you may receive treatment with botulinum toxin. Some surgeons use this as a way to pinpoint the right location for migraine surgery.

Plastic surgeons have observed that the surgical techniques used in migraine surgery are very similar to those used in facial cosmetic surgery. In fact, plastic surgeons suggest that procedures intended for rejuvenation of the face may reduce migraines as well.

Indications

In general, surgery is considered for people who have not improved with migraine medication or who experience intolerable side effects from such drugs.

There have been some attempts to identify whether there can be predictors of improvement with migraine surgery. Some doctors suggest that people whose migraines improve in response to botulinum toxin injections may also improve with other procedures.

Types of Migraine Surgery

There are several types of procedures aimed at relieving chronic migraines. They involve transection (cutting) of a muscle or nerve, or decompression of a nerve when in close contact with a blood vessel. In rare instances, a tumor, growth, or bone may be removed if that is considered the cause of migraine attacks.

Muscle Transection

If your migraines have improved with botulinum toxin, you might also improve if you have a lesion (cut) in the same muscle(s) that responded to the injections. Keep in mind that botulinum toxin is generally injected into several muscles, but migraine surgery would only involve a lesion in one or two muscles.

Some people improve with botulinum toxin, but then become "immune" to the effects, and surgery can potentially be a good solution in these situations. However, a surgical lesion placed into a muscle can cause weakness of that muscle.

Nerve Transection

In some instances, a sensory nerve or a small nerve branch can be surgically cut to alleviate pain. This type of procedure prevents the nerve from transmitting pain, but it can lead to numbness, tingling, and even sometimes create further pain.

Nerve Decompression

A blood vessel can compress a nerve, causing nerve sensitivity. In such instances, the blood vessel can be gently "moved" to alleviate the physical pressure.

Removal of a Growth

A tumor (benign or malignant) or a bone malformation may cause worsening of migraines due to an increase in pressure inside the head. If the growth is removed, symptoms may improve.

Efficacy

There is growing evidence that migraine surgery may work for some people. A number of small research studies have shown that some participants with refractory migraines may experience a greater than 50 percent reduction in migraine frequency, with a decreased need for medication for at least a few years after surgery.

But one of the leading concerns in assessing these results is that migraine surgery is a type of procedure that is prone to inducing a placebo response. This refers to an improvement in symptoms from the inherent bias and psychological effect of undergoing treatment, rather than from the treatment itself.

Also, reports suggest that even among research participants who are carefully selected for surgery, the success rate ranges from less than 50 percent to around 80 percent. So, it is quite possible that you might not experience any improvement of your migraines after having one of these procedures.

In addition, many of the studies have shown flaws in their design, prompting the American Headache Society to recommend against the use of migraine surgery outside of a clinical trial.

Side Effects

There are few side effects and adverse events reported with this type of surgery, but negative outcomes can occur. The most common side effects include nasal discharge, dryness of the nose, and scalp itching.

Complications including infection, weakness or paralysis of the muscles, or post-operative scarring may occur.

A Word From Verywell

Migraines, especially refractory migraines, can have a major impact on your quality of life. Surgery is a potential—but not yet proven—treatment option for migraine prevention. Be sure to talk with your doctor about all of your migraine-prevention options (lifestyle strategies, complementary and alternative therapies (CAM), and medication) and whether or not participating in a trial where surgery is being studied as a treatment for chronic migraine may be right for you.

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