Surgical Treatment for Migraines

Migraine surgery techniques show significant and lasting improvement

More than 30,000,000 Americans (18% of females and 6% of males) suffer from migraine headaches that often seriously interfere with their lives, and current medication therapies only help about one-third of sufferers. Now, a recent 5- year study shows that innovative craniofacial surgery can offer a significantly better treatment approach.

Surgical Treatment for Migraines
In the study, “Five-Year Outcome of Surgical Treatment of Migraine Headaches” published in Plastic and Reconstructive Surgery, February 2011, 88% of 69 patients in the test group experienced a positive response to the surgery after 5 years. A total of 29% experienced a complete elimination of migraines, and 59% had a significant decrease in symptoms, defined as at least a 50% reduction in intensity, frequency and duration of migraine headache. Only 8% experienced no significant change.

The idea of using surgery to treat migraines started 11 years ago, when a forehead-lift patient reported to her plastic surgeon, Bahman Guyuron, MD, that her migraine headaches had completely disappeared. Since then, Dr. Guyuron has been the lead author of many studies showing promising results for migraine patients using “trigger site” surgery. Bahman Guyuron is Kiehn-DesPrez Professor and Chair, Department of Plastic Surgery at Case Western Reserve University and University Hospitals Case Medical Center.

According to the World Health Organization, migraine alone ranks 19th among all causes of years lived with disability. A migraine is a serious headache disorder with a strong genetic predisposition. It can last for a few hours or up to 2-3 days at a time and can occur once or twice a year for some people or several times a month for others. Women are three times more likely to get a migraine than men. It can be preceded by an aura, or visual disturbances such as bright lights or blank patches. Migraine pain is often severe and debilitating, can be made worse by movement, may involve light and sound sensitivity, and sometimes leads to vomiting.

The causes of migraine are still not completely understood. In general, something activates a mechanism deep in the brain to cause an inflammatory response around the nerves and blood vessels of the head. Dr. Bahman Guyuron explains, “The current hypothesis is that the nerves of migraine patients are more vulnerable. There is a genetically-predisposed condition among those who get migraines: they have nerves that are more vulnerable to irritation than non-sufferers, so they are more prone to getting migraines.” His team is currently conducting an extensive study to examine more closely what is causing the vulnerability.

Migraine surgery involves removing some of the muscles around major nerves in one or more of four identified trigger sites – frontal, temporal, intranasal and occipital. A neurologist confirms a diagnosis of migraine in all patients before they are considered candidates for surgery. In the 5-year study, botulinum toxin (Botox) injections were used to identify one or more trigger sites specific for each patient. In practice now, however, Dr. Guyuron relies on an assessment of the patient’s constellation of symptoms and CT scan to determine the trigger sites with the same accuracy as the Botox detection method.

The surgery takes about 2.5 hours on average and is done on an outpatient basis. Patients can usually return to normal activities in about 3 weeks. In the study, the frequency of attacks decreased from about 11 to 4 per month, the average duration decreased from 34 to 8 hours and patients reported a significant decrease in the intensity of migraine pain. No serious complications were reported and side effects for some included occasional neck stiffness and skin numbness.

Dr. Guyuron says that the most common feedback he hears from patients after successful surgery is “you have given me control of my life.” He reports that they are more than willing to trade the risks of a little stiffness or numbness for the debilitating pain of migraine headaches. He says, “Migraine surgery doesn’t work for everybody, not every time, but we are working on improving the results all the time.”


Visit the American Headache Society for information and tools for patients and healthcare professionals, such as the MIDAS questionnaire, (Migraine Disability Assessment Test) which can help measure the impact headaches have had on your life over the last 3 months. Learn more about the Global Campaign to Reduce the Burden of Headache Worldwide, a joint effort by WHO, World Headache Alliance, and International Headache Society.

Originally published on GE Healthy Outlook, November 3, 2011. Copyright Jane Langille.

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