Migraine surgery is indicated for patients who are unresponsive to conventional therapies. When successful, patients report an improvement in migraine frequency, duration, intensity, and in many cases complete relief of their migraines.
IS MIGRAINE SURGERY RIGHT FOR YOU?
In the past, migraine headache has 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. Surgery can help this specific group of patients. Also, migraine surgery can be a solution for patients who depend on Botox for symptomatic relief.
HOW ARE PATIENTS SELECTED?
Patients are referred to our center from their Primary Care Physician, Neurologist or Pain Specialist office. We ask our patients to fill a migraine log/diary form and questionnaires before their consultation with our Plastic Surgeons. During their visits, candidates are carefully evaluated and selected based on their history, symptomatology, failure of alternative therapies/treatment, and risks/benefits of undergoing surgery.
WHAT TO EXPECT…
- Patients should have been worked up by their Primary Care Physician, Neurologist, PCP or pain specialist. Alternative (pharmacologic and non-pharmacologic) therapies should have been tried and the patient found to be unresponsive.
- Fill out the migraine log and questionnaires before the initial visit
- Schedule a consultation at FACES+ for evaluation by our Plastic Surgeons. Out of town patients can schedule a Skype consultation. Concierge Services are available and range from simple recommendations to full VIP services pre-booked for the entirety of your trip.
- If you are a good candidate for surgery, all risks, benefits and alternatives of the procedure will be discussed in detail and all your questions answered.
- Based on the location of the trigger point and the pre-operative evaluation, the nerve branch responsible for the symptoms is explored and surgically released. Surgery is minimally invasive and is typically done through small incisions that can be placed within the hair bearing scalp so that scars are hidden and minimal.
- Depending on the trigger point and risks of anesthesia, procedures may be done with local anesthesia and sedation. You will be evaluated by our Plastic Surgeon and Board Certified Anesthesiologist to help make this decision. Surgery does not remove or go through the skull or the brain.
- It can take anywhere from 15 minutes to 1 hour to deactivate each trigger point and release the affected nerve. Migraine Surgery typically takes 1-2 hours to complete, depending on the number of trigger sites.
- All surgeries are done on an outpatient basis.
- Patients go home the same day
- Recovery depends on the location and number of triggers. Slight bruising and swelling may occur, and typically subside within 1-2 weeks. The majority of patients return to work and normal activities within that 1-2 week period.
- Most incisions are not visible and are hidden in the scalp or in the upper eyelid.
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. Procedures such as facelift, forehead lift, blepharoplasty, rhinoplasty, and necklift can be done in conjunction with Migraine surgery if indicated.
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.
DR. COHEN RESTORED MY CONFIDENCE AND HEALTH FROM AN EARLIER HORRENDOUS PLASTIC SURGERY EXPERIENCE PERFORMED BY ANOTHER DOCTOR. DR. COHEN GAVE ME BACK MY CONFIDENCE, TRUST, AND SATISFACTION WITH A NEW STANDARD OF PLASTIC SURGERY CARE.