Surgery for Migraine Headaches

Surgical decompression of the peripheral sensory nerves around the skull can have a beneficial effect on the frequency, severity and duration of the migraine headaches. Surgery is performed as an outpatient procedure under local or (usually) general anesthesia and usually takes one to two hours. Some patients have multiple migraine triggers and surgery may take longer if the trigger sites are on different areas of the head. Surgery is not on the brain and we do not remove or go through the skull bones.

What is the surgery’s success rate?

Most studies have shown success rates above 70 percent, with roughly one-third of the patients experiencing total relief of their migraines. When successful, patients report an improvement in migraine frequency, duration, intensity and in health-related quality-of-life.

Who is a candidate for migraine surgery?

• Patients who have been diagnosed with migraines by a neurologist (not all headaches are migraines)
• Patients with sites of nerve compression identifiable with a high degree of confidence
Several other factors are considered, including the efficacy (or failure) of medical treatment, side effects of medications and the severity of the migraines. Patients with a favorable response to Botox® or local anesthetic injections are generally good candidates for migraine surgery.

Will I experience side effects or have scars?

Most complications are minor and temporary, and will vary according to the specific surgery. Treatment of migraines around the eye might actually improve the appearance of the forehead by decreasing wrinkles and correcting sagging eyebrows. Complications include wound healing problems, nerve injuries, bleeding and failure of surgery to ameliorate the headaches.

Most of the incisions are well hidden, either in the scalp or in the upper eyelid.

How long is the recovery?

Slight bruising and swelling may occur, and typically resolves within two weeks. Most patients are able to return to their usual activities in the same time frame. Depending on the specific nerves targeted by surgery, patients might be asked to avoid strenuous exercise for up to three weeks.