Migraine is a neurologic disorder characterized by recurrent and debilitating episodes of headache that usually present with a variety of other symptoms. These symptoms include nausea, vomiting, photophobia (fear of light), and phonophobia (fear of sound), which can occur with unpredictable intensity and vary from person to person as well as from one attack to the next. The pain caused from a migraine attack can be so severe that it is debilitating, lasting anywhere from a few hours to a few days in worst cases.
Migraine headaches affect almost 35 million Americans (18% of women and 6% of men in the United States). The prevalence of the disease is highest between ages of 25 and 55, corresponding to peak years of productivity. Migraine headaches can affect every aspect of a patient’s life as they can be considered a major psychological and economic burden as well as physically disabling.
Traditionally, migraines have been treated exclusively with behavioral and pharmacologic therapies. Although there has been a significant advancement in both fields, many patients remain unresponsive to either therapy.
In the early 2000s, it was accidentally discovered that patients who had underwent forehead lift surgery had complete resolution, or significant improvement, in their migraine headaches. It was theorized that nerve compression is a major cause for these symptoms. Since then, migraine surgery has developed and evolved to treat multiple types of the disease.
So far, we have identified multiple trigger points (sites of compression) in the head, specifically, in the forehead, temples, between the eyes and in the back of the head. For each trigger site, specific techniques have been developed to release the structures irritating the nerve responsible for the symptoms.
The procedure involves release of entrapped peripheral nerves through small access incisions that can be concealed within the scalp hair without any visible scars. Migraine surgery is indicated for patients who are unresponsive to conventional therapies. Significant improvement or complete elimination of symptoms and episodes are very common after surgery. All procedures are done on an outpatient basis under local anesthesia with or without sedation or general anesthesia with short recovery time.