Migraine Surgery-Is It Right For You?

People who get migraines know how debilitating they can be. Triggers vary from person to person, and the severity of the headache differs. Some people don’t develop a headache with their migraine. Triggers range from stress to bright light and loud noises. Some people report symptoms when they have eaten certain foods or haven't eaten for extended periods.  

In addition to headaches, migraines can cause a variety of other symptoms, such as sensitivity to light and sound, nausea, vomiting, or vertigo. Each person describes their migraine attack differently, and treatment ranges from prescribed medications to lifestyle changes.  

One study discovered staggering results. One in six Americans¹ reports having migraines. During childhood and preteen years, boys and girls are affected almost equally, but most adult sufferers are women. Once women reach menopause, there is a decline in the rate. 

Many are looking to migraine surgery as a permanent solution, but is it effective?

What is migraine surgery?

Since migraine is a complex condition with multiple causes and symptoms, some doctors disagree on surgical remedies. But if you’ve exhausted medications, diet modifications, other lifestyle changes, and even botox injections, you're probably anxious for a more permanent solution. 

Though most neurologists disapprove of migraine surgery, one follow-up study² suggests that surgical results outweighed the medicinal effects. Surgeons offer several procedures, but many scientists claim that studies are insufficient to deem these a "cure."

Who can undergo migraine surgery?

The American Headache Society³ (AHS) does not recommend surgery for migraine headaches unless you are participating in a clinical trial. The society doesn’t believe scientists have performed enough clinical research. Although it sees the possible benefits of surgery, it doesn’t believe there is enough information on side effects. The AHS wants larger, more in-depth trials before endorsing surgical procedures.

However, if your neurologist has talked to you about surgery, you may still be considering the procedure. You may be a good candidate if:

• A neurologist diagnosed you with migraines.

• Other treatments were unsuccessful. This includes lifestyle changes, prescribed medications, and other treatments such as botox.

• You are generally in good physical health.

• Your doctor has discussed realistic surgical outcomes.

When contemplating surgery, you and your physician should be able to identify the area of your head most affected by the headache: The forehead, nasal area, base of the skull, or behind the ears. By isolating the area, surgeons can better determine the type of surgery that may offer the most relief. 

Identifying your triggers is useful, and It can also be helpful to note the type of migraine you have:

• Migraine with aura

• Migraine without headache

• Migraine without aura (most common)

• Migraine aura without headache

Types of migraine surgeries

Many neurologists and headache specialists may not recommend migraine surgery, citing limited data and studies.  However, surgeons still perform migraine surgeries with varied success rates. 

Peripheral neurolysis

The most common migraine surgery is peripheral neurolysis, an umbrella term for several different procedures. The surgeon uses a technique to relieve pressure on nerves that bone or muscle may be pinching or compressing. The procedure involves injecting a local anesthetic around the nerve branches near the site where you identify the pain. 

Another form of peripheral neurolysis involves cutting the nerve completely. The surgeon moves the ends of the nerves beneath the muscles to prevent compression from returning. Some surgeries are more complex than others, depending on where the pain is. On some occasions, endoscopic surgery allows for faster recovery and smaller incisions.   

Turbinectomy and septoplasty

A turbinectomy is a surgery that removes turbinates from your nasal area. Turbinates are the small bony structures inside the nose that help you breathe freely. 

Some people get turbinectomies to correct snoring and chronic congestion and improve sleep apnea symptoms. People with deviated septums often undergo a turbinectomy in conjunction with a septoplasty to correct the problem. 

When turbinates grow too large, they may contribute to headaches. A turbinectomy involves a surgeon shaving some of the enlarged turbinates to alleviate pressure, aid breathing, and ease migraines and sinus issues.

A septoplasty helps you breathe better and relieves nasal congestion and headaches. Though the surgery may ease sinus problems, it is uncertain if it will alleviate migraine headaches. 

Neuromodulation

Neuromodulation sends electromagnetic pulses through the skin, targeting nerves the clinician identifies as possible triggers. Currently, only external devices have been FDA-approved for migraine treatment. Clinical trials are investigating the safety and effectiveness of devices implanted under the skin. 

Many neurologists who opt for neuromodulation combine the therapy with prescription medications. Some patients do not like how electromagnetic pulses feel, so it may not be the right treatment for you if you're affected by sensations.  

Is migraine surgery effective?

There seem to be many opposing opinions on the effectiveness of migraine surgery. In a comprehensive review,⁴ the authors cite 39 published articles demonstrating that migraine surgery contributed to reducing migraine symptoms and frequency. In addition, the American Society of Plastic Surgeons notes a 94% success rate⁵ in seventy surgeries performed for frontal trigger site deactivation for migraine surgical therapy.   

On the other hand, another study⁶ found that in a group of 627 patients, only 38% of migraine symptoms were reduced or eliminated.  Researchers, neurologists, and analysts agree they need more information before determining the effectiveness of surgical treatments for migraines.   

How to prepare for migraine surgery

Before deciding on migraine surgery, discuss the risks and results with your surgeon. Ask questions about their experience with the surgery and the results they have had in the past. Ask if there are other non-surgical treatments you should try before migraine surgery. 

Get all the information you can on the length of the surgery, the recovery time anticipated, and what the expectations are. Check if your doctor expects you will still need to continue taking your prescribed medications, and if so, for how long. 

Schedule the procedure once you have thoroughly exhausted your questions and feel surgery is your best option. 

Depending on the type of surgery you are having, the procedure will usually take from one to four hours. Your surgeon should explain typical surgical preparation, and it will usually include:

• Pre-surgical lab testing or scans, such as blood tests or an MRI

• Reviewing your medications. Your doctor may ask you to stop taking certain medications before surgery

• Reviewing over-the-counter supplements and prescription drugs

• Quitting smoking if you haven’t already

• Reducing or eliminating certain foods such as caffeine, alcohol, and preservatives

Is migraine surgery safe?

Though plastic surgeons contend that minimally invasive migraine surgery is safe,⁷ many clinicians disagree. With insufficient data and limited studies, many scientists do not recommend surgery as a solution for migraine sufferers. Until researchers have completed further clinical studies on migraine surgeries, we cannot determine success rates, complications, and long-term effects.

Risks and complications of migraine surgery

All surgeries have risks. As we don’t have enough information on migraine surgery, we don’t know all the risks. Some known risks are: 

• Nerve injury or damage: An infrequent complication that’s usually temporary

• Hair loss at the incision site: Usually a tiny area that’s unnoticeable most of the time 

• Dry or irritated eyes: If you have dry eyes, migraine surgery may make them worse.

• Risk of bleeding, scarring, scar tissue, or infection.

• If undergoing septoplasty or turbinectomy, there could be some loss of sense of smell.

Recovery time

Immediately after surgery, expect one to five hours in recovery before your doctor sends you home. Your doctor may recommend resting for the first day or so once you’re home. Most people return to work and normal activities within the first two weeks following surgery. 

You will likely have some bruising and swelling for the first couple of weeks. The severity and exact location depend on the type of procedure and the number of trigger points.  

You may continue to have some inflammation or discomfort for up to two months after surgery. Still, it’s usually minor, and you can control it with an oral or topical medication. You may experience temporary mild pain or numbness at the surgical site, which you can manage with medication.

The lowdown

Migraines are common among Americans, with approximately 12% of the population suffering from migraines. Surgery may seem like a promising treatment, but there are still doubts in the medical community.

Though some data supports its effectiveness, most neurologists and other headache specialists agree that we need more data before deciding on the safety of migraine surgery. Speak with your headache specialist for options for treating your migraines.