Migraine Surgery Options

These may be considered when other treatments have been unsuccessful

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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 used, including procedures aimed at releasing muscle tension and procedures that focus on relieving nerve compression.

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, suggesting that there is still a lot that the medical community needs to learn about migraines.

The theory behind migraine surgery is that if the effects of muscle relaxers or botulinum toxin can temporarily prevent migraines, then surgical removal of a compressing structure (a muscle or nerve branch) 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 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 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 is expected to result in loss of all sensation.

The branches of the trigeminal nerve transmit sensation in the head and face and may need to be cut as a treatment for trigeminal neuralgia. This procedure has also been used to alleviate chronic, refractory migraines.

Blood Vessel Decompression

A blood vessel can compress a nerve or a muscle, causing nerve sensitivity or muscle spasm. In such instances, the blood vessel can be gently "moved" to alleviate the physical pressure. If the blood vessel has an aneurysm (an outpouching), the aneurysm can be tied off to prevent blood from flowing through the outpouching.

This procedure causes the aneurysm to wither away, relieving the pressure on nearby structures.

Removal of a Growth

A tumor (benign or malignant) or a bone malformation may cause chronic migraine pain due to pressure on a nerve or muscle. 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.

Though the goal is only to have migraine surgery once, there are attempts to predict whether certain techniques may necessitate additional procedures.

Overall, the sheer number of studies involving migraine surgery is low, and you should weigh all of your options before deciding to have such a procedure.

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 among the many treatment options used 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 surgery may be right for you.

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