About Migraine Surgery
Migraine headaches affect up to 20% of the US population and can dramatically interfere with work, school, family events and all other aspects of a person’s life.
Many patients are able to control their migraines with medications. However, there are many who continue to have attacks despite being on any medical treatment. These patients spend years seeing different doctors and trying numerous medications without success. Attacks can be set off by certain foods, smells, hormonal fluctuations, or stress. In some patients nothing specific can be found.
Recent medical evidence has shown that in some patients the migraines are caused by the irritation of certain nerves in the head and neck. The muscles that surround these nerves usually cause this irritation which lead to a full-blown migraine attacks. These nerves are located in well-defined areas and are divided into trigger points depending on where the headaches usually start: the frontal, temporal, occipital, and nasal trigger points.
Migraine surgery works by releasing the pressure on these trigger points after we have identified them, and preventing the migraine from starting, or at least making them occur less often and with less intensity.
To identify the trigger points, the muscles around the suspected areas are first injected in-office with BOTOX® or local anesthesia to paralyze them and keep them from irritating the nerves. If this succeeds in improving the headaches then surgery has a high likelihood of succeeding. Surgery does not always provide an absolute cure for the migraines, although it does in some cases. In most people, it dramatically improves the attacks, in frequency, intensity and duration so that patients can resume a normal life without being debilitated every time they get the headaches.
Multiple studies have confirmed that migraine surgery is very successful in well selected patients. Success rate approaches 90%. Most patients witness at least a 50% reduction in migraine frequency, intensity and duration. Some patients, about 35%, are fortunate enough to have complete elimination of migraines from their life.
If you have been diagnosed with migraine headaches by a neurologist, have tried medical therapy without success and have at least two migraine headaches per week, consider having migraine surgery in New Jersey with Dr. Adam Hamawy. Dr. Hamawy is a cosmetic surgeon with extensive experience performing this surgery and has helped many patients eliminate migraines from their life. He is certified by the American Board of Plastic Surgery and the American Board of Surgery.
Your first visit with Dr. Hamawy will determine if you are a good candidate for surgery. During this visit, Dr. Hamawy will ask you about your migraines and confirm if you are a good candidate. Be prepared to discuss all your prior migraine therapy as well as any other medical conditions you may have including allergies, prior surgeries and medications, vitamins or other supplements that you currently take. It is important for you to provide complete information.
Once it is confirmed that you are a good candidate, BOTOX® will be injected into the appropriate trigger points and you will be asked to follow up in four weeks. During this time it is important to continue maintaining and recording a headache log.
If after four weeks you have significant improvement, then surgery has a high likelihood of being successful and surgery will be scheduled. If no improvement is noted, then unfortunately surgery will probably not help and treatment will be terminated. In some cases the trigger point that was injected improves however new additional trigger points were unmasked and they are now causing headaches. In this case, the new trigger points will be injected and a new evaluation performed in four weeks.
Frontal Migraine Surgery
This is performed for patients who have migraines that are triggered above the eyes and can be through small incisions hidden in the upper eyelids or hidden in the hairline of the scalp. The techniques is very similar to the approach plastic surgeons use for cosmetic of surgery of the eyelids or eyebrows. To take the pressure off the nerves, the muscles that normally make you frown are removed. Both sides are treated even if the symptoms occur on only one side to avoid having facial asymmetry.
Temporal Migraine Surgery
For migraines that usually start from the side of the head or temples, a small nerve, the zygomaticotemporal nerve, is released through the temporalis muscle. This also is performed through very small incisions hidden in the scalp.
Occipital Migraine Surgery
This approach is used for headaches that normally start at the back of the head or neck. They are usually caused by the greater occipital nerve being pinched by the Semispinalis Capitis muscle and by the greater occipital artery and vein. Surgery involves releasing the nerve from the structures applying pressure including the muscle and vessels thru a small incision on the back of the head.
Nasal Migraine Surgery
Nasal migraine headaches usually start behind the eyes and around the sinuses and nose. They are triggered by the nerves being pinched by a deviated nasal septum inside the nose. These migraine headaches are often weather related and may be worse when the nose is congested. Unlike in the other trigger points, BOTOX® cannot be used to confirm this. Therefore, in patients with a noticeable deviated septum, and in those not responding to BOTOX®, a CT scan will be needed to determine if a deviated septum is the reason for the migraine.
Surgery can take from 2 to 6 hours depending on the number of areas to be addressed. Most patients go home the same day. Some discomfort is normal following surgery, however, there is usually not a lot of pain. When you are discharged, you will be given prescriptions to keep you more comfortable. You may shower the following day. Most patients return to work after one or two weeks, however, plan on having limited physical activity and restrictions against exercise for at least four weeks.
Your follow-up visits will usually start five to seven days following your surgery for a checkup. During your postoperative visits, Dr. Hamawy will review activity limitations, incision care, and concerns you may have. Following this visit you will return in approximately 3 weeks, 3 months, 6 months and one year.
It is important to remember that you may still have some headaches after surgery but they should be much less frequent and no where near as intense as the migraines you had before. Be assured that your relationship with Dr. Hamawy does not end after your surgery. If you have any concerns during your recovery, or have more questions at a later time, you can always contact Dr. Hamawy.
After your initial consultation, you will be quoted a price that will include Dr. Hamawy’s fee as well as the operating room and any anesthesia fees. Please check with your insurance to see if they cover the BOTOX® injections for migraine headaches as well as their coverage for the migraine surgery. Financing options are available if needed, if not covered by insurance.
LENGTH?: 2-4 hours depending on the number of trigger areas
IN/OUTPATIENT: Outpatient or one night in hospital
RECOVERY: Return to work: 1 week – Light exercise: 2 weeks – Return to full activity: 4 weeks