The goal of migraine surgery is to reduce or eliminate headache frequency, duration and pain. Migraines can be associated with compression and irritation of sensory nerves and vessels around your head. When these compression points are released during surgery, the severity of migraines may decrease or you may not experience further migraines.

Sites of nerve compression are also known as trigger points. You may have one or several trigger points depending on your symptoms. The most common and main trigger sites are frontal (pain above your eyes and/or your forehead), temporal (pain over your temples), rhinogenic (pain inside your nose that can extend to behind your eyes), occipital (pain on the back of your head that can radiate across your skull to your eyes or behind your eyes). You may also experience pain at less common sites around your head.

Who is a good candidate for migraine surgery?

Migraine surgery is a highly individualized procedure. Depending on your symptoms, you may be eligible for trigger point release at different sites.

In general, you may be a good candidate for migraine surgery if:

• You have been diagnosed with migraines or occipital neuralgia by a neurologist (not all headaches are migraines)
• You have tried several therapies (behavioral, medications) without success
• You are physically healthy
• You have realistic expectations

What are the risks of migraine surgery?

The decision to have migraine surgery is an extremely personal one. You’ll have to decide if the potential benefits will achieve your goals and if the risks and potential complications of migraine surgery are acceptable.

The possible risks of migraine surgery include, but are not limited to:

• Anesthesia risks
• Asymmetry in muscle functions
• Bleeding, perhaps requiring a transfusion
• Deep vein thrombosis, cardiac and pulmonary complications
• Fatty tissue found deep in the skin might die (fat necrosis)
• Fluid accumulation (seroma)
• Hematoma
• Infection
• Permanent numbness or other changes in skin sensation
• Persistent pain
• Poor healing of incisions
• Possible need for secondary procedures should, for example, a neuroma occur
• Skin discoloration and/or prolonged swelling
• Skin loss
• Suboptimal aesthetic results
• Unfavorable and/or visible scarring

How should I prepare for migraine surgery?

In preparing for migraine surgery, you may be asked to:

• Get lab testing or a medical evaluation
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Migraine surgery is typically performed in a hospital or licensed ambulatory (outpatient) surgery setting. The operation is typically done under general anesthesia. If your surgery is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

What should I expect during my migraine surgery recovery?

Following your migraine surgery, you will have minimal dressings if any. Controlling swelling and incision care is important. Sometimes the nerves can be irritated post-operatively requiring pain medication. In more rare cases nerve modulator medications may be utilized as well.

You will be given specific instructions that may include:

• How to care for your surgical site(s) following surgery
• Medications to apply or take orally to aid healing and reduce the risk of infection
• Specific concerns to look for at the surgical site or in your general health
• When to follow up with your plastic surgeon.

What results should I expect after migraine surgery?

Migraine surgery can reduce migraine frequency, duration and severity in appropriately selected patients. Studies have shown that between 70% and 95% of patients undergoing surgery experience improvement or complete elimination of migraine headaches.

While some patients see an immediate improvement in their headaches, others can only appreciate the effect of surgery after several months.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and a second operation may be necessary.

Sometimes, intense pain masks another area of pain. If you are experiencing pain at the site of surgery or in a different area, see your plastic surgeon in the office. A second site of pain may have been unmasked by your first surgery.