Surgery For Migraine Relief: Fad Or Fact?
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If frequent, painful migraine headaches keep interrupting your pursuit of a happy, productive life, you may be open to any and all options for possible relief — even surgery.
"Before considering surgery, I’d recommend exhausting other treatments that have fewer side effects."
Two surgical techniques used to treat migraines are receiving mixed reviews from doctors. Plastic surgeons who perform the procedures have reported favorable results for a majority of their patients. Headache specialists feel more research is needed.
One procedure, called nerve decompression, removes tissue that puts pressure on one or more peripheral sensory nerves in your head thought to be trigger points for migraines. The other, called neurectomy, cuts a nerve in your head identified as contributing to migraines. The nerves lie on the surface of your skull and aren’t part of your brain.
The procedures evolved as patients who received eyebrow and forehead lifts were reporting back to their plastic surgeons a decline in migraine headaches following the cosmetic surgery.
Before proceeding with surgery, plastic surgeons generally require that a neurologist confirm the diagnosis of migraine. An important diagnostic challenge is to identify which nerve or nerves are trigger points for the migraines. They could be in the temple, the front of the head, or the back of the head.
Surgeons also assess what medications or other treatments you’ve tried and whether they have failed. If you have had a favorable response to Botox® or local anesthetic injections, you may be considered a good candidate for migraine surgery.
Cautions From Headache Specialists
Despite reported successes, many neurologists and headache specialists are reluctant to embrace these surgeries as part of the standard treatment for migraines. They want to see more study. And, the US Food and Drug Administration has not approved the procedures for migraine relief.
Richard Kim, MD, neurologist and headache specialist, thinks that cutting or decompressing a nerve to “cure” migraines is too simplistic.
“Migraine is a genetic disorder. It’s not just a peripheral mechanism. The headache community thinks there’s not enough good data to know if these headache procedures are really effective or not.”
Dr. Kim explains that 80 percent of people with migraines report a family history of migraine.
Click play to watch the video or read video transcript.
He cites an article on the Choosing Wisely website of the American Board of Internal Medicine Foundation (ABIM). In the 2013 article, the American Headache Society advises physicians: “Don’t recommend surgical deactivation of migraine trigger points outside of a clinical trial.”
Both Dr. Kim and the Headache Society are concerned that current evidence is based on small controlled trials and observation. They advocate for large multicenter, randomized, controlled trials with long-term follow-up to provide more definitive proof that these surgeries will have lasting benefit and not cause harmful side effects.
“The surgery may work, but good, quality, evidence-based research is not there. A lot of the studies on these procedures have been criticized for not carefully defining which patients would be appropriate for this. We also don’t know if patients continued with preventive medications, which would affect the results.”
Other Migraine Relief Options
Patients have several other treatment options beyond medication and surgery, he notes, including Botox®, nerve stimulation devices, behavioral therapies and acupuncture.
Dr. Kim’s final analysis at this time is: “These surgeries have potential complications such as persistent numbness, tingling and pain. Before considering surgery, I’d recommend exhausting other treatments that have fewer side effects and would be less harmful.”
Always consult with your doctor about what’s best for you.
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Source: Richard Kim, MD, neurologist and headache specialist, Premier Health Clinical Neuroscience Institute; Plastic and Reconstructive Surgery; American Society of Plastic Surgeons; UW Health (University of Wisconsin); Choosing Wisely Campaign of the ABIM Foundation
