Migraine Surgery Candidates: What You Need to Know
The Migraine Institute is a leading provider of minimally invasive migraine surgery treatments. We use advanced migraine decompression surgery techniques to address a patient’s migraine triggers and permanently remove faulty nerve signals that cause your migraines.
Are You a Candidate for a Minimally Invasive Surgery?
Not all migraines are created equal, and different migraine sufferers have different underlying causes. Migraine surgery is ideal in treating migraines related to one of several muscular/nerve trigger points. One trigger point is located inside the nose, and the remainder are located around the face, scalp and neck.
Nerve decompression surgery is a complex procedure. Dr. Jonathan Cabin of The Migraine Institute will conduct an in-depth evaluation to determine if you are an appropriate candidate for this approach. Prior to an initial consultation with Dr. Cabin, a patient must have a diagnosis of chronic migraines from a neurologist and feel that medications are ineffective or cause unwanted side effects. Dr. Cabin requests a detailed medical history from each patient and performs a comprehensive physical exam. He also uses specialized tests and trigger point confirmation techniques as part of a comprehensive patient assessment. If Dr. Cabin determines a patient is a viable candidate for surgery, he then develops a customized surgical plan based on his or her migraine triggers.
What are Migraine Trigger Points?
A migraine trigger point refers to a specific sensory nerve on the face, scalp or neck that, when irritated, sets off a domino effect that can lead to a migraine. With effective migraine trigger point confirmation, a patient can appreciate the link between a specific trigger point and the migraine pain that he or she experiences.
The most important tools in confirming trigger points is the use of a detailed patient history, migraine log and in-office examination. Frequently, other techniques will be required including doppler testing and/or BOTOX®/nerve block injections. Depending on the trigger point(s) involved, a CT scan or course of medication (like nasal steroid spray) may also be required for further confirmation.
A doppler is a special device that uses sound waves to detect blood vessel pulsations. It is particularly helpful in localizing arteries that may be irritating trigger point sensory nerves. These arteries can be treated to eliminate the migraine trigger.
BOTOX® injections relax muscles around a nerve (some new studies suggest that it may actually work directly on the nerve, as well). It takes BOTOX® about 3-5 days to start working and 2 weeks to get to its maximal effect. If BOTOX® treatment in a certain area reduces or eliminates migraine symptoms, this suggests that this may be a trigger point.
Nerve blocks work more immediately by blocking signal transmission for a specific nerve. This can also help determine whether a particular area is a trigger point, especially if the patient is actively in the early stage of a migraine when the injection is performed.
Steroid nasal spray is administered through the nostrils to shrink the internal lining of the nose. When nasal spray helps to reduce or eliminate migraines, then this can serve as confirmation of a nasal trigger point.
Is Migraine Surgery Effective?
Migraine surgery is custom-tailored to your specific triggers and is designed to permanently eliminate a particular nerve irritation. In most patients, surgery dramatically reduces the duration, intensity and frequency of migraines. Roughly half of all patients have no migraines after migraine surgery.
Set Up a Consultation with Dr. Cabin at The Migraine Institute
Alleviating migraine pain can be challenging, particularly for chronic migraine patients who have struggled to achieve their desired results with medications and other traditional migraine treatments. Fortunately, The Migraine Institute offers minimally invasive migraine surgery that has been shown to help patients reduce or eliminate migraine pain.
To schedule a consultation with Dr. Cabin and The Migraine Institute team, please contact us today at 310.461.0303 or fill out our online form.
Surgical Candidates and Work Up
Should I Schedule a Consultation?
In order to be considered for surgery, you must have a diagnosis of migraine headache from a neurologist within the past five years. Surgery is only effective in those suffering from migraine headaches, and many types of headaches can present similarly to migraines.
Other considerations in patient selection for surgery include the effectiveness and suffered side effects of your migraine medications, as well as the severity of your headaches. A favorable response to BOTOX® (or nasal spray, for the nasal trigger) will be required to confirm that surgery will be effective. If effectiveness of BOTOX® and/or nasal spray is confirmed from an outside physician, it is typically not necessary to perform this confirmation in our office.
Concurrent Cosmetic Surgery
You may opt to have one or more cosmetic procedures at the same time as your migraine surgery. In many cases, the same incisions can be used to address your migraines and perform aesthetic surgery to the eyes, brows and/or nose.
Before surgery, you will need to complete bloodwork and receive a general medical examination from an outside doctor. You also may need additional medical clearance based on your age and health.
Overview of Migraine Surgery
Two weeks prior to your surgery, you will be asked to stop taking any blood thinning prescriptions or supplements. By doing so, you can reduce the risk of excessive bleeding during the operation. If you are dependent on blood thinning medications due to a severe medical condition, we will need to consult with your managing physician to explore various alternative options. You will be asked to refrain from eating or drinking starting the night before migraine surgery. This will ensure anesthesia can be administered safely and effectively on the day of your surgery.
Depending on the patient and the trigger sites involved, the surgery can be performed after a patient receives local anesthesia. Or, in some instances, migraine surgery will be performed under deep sedation or general anesthesia.
The decision to administer migraine surgery under deep sedation or general anesthesia may vary based on a patient’s trigger points, medical conditions and age. Before migraine surgery, a facial plastic surgeon will conduct an in-depth assessment of a patient and offer anesthesia recommendations. This will ensure anesthesia is administered properly at all times.
Length of Migraine Surgery
Migraine surgery usually takes about one to three hours to complete based on the treatment location and trigger points. A facial plastic surgeon will discuss what to expect before, during and after migraine surgery. By doing so, a migraine surgery patient will know exactly what to expect at all stages of the procedure.
Incisions and Approach
During migraine surgery, a facial plastic surgeon will make incisions within the hair on the scalp or within the upper eyelid creases. These incisions typically heal with no visible scar. During a migraine surgery that involves a nasal trigger point, a facial plastic surgery will make incisions within the nose, completely hidden from view.
Migraine surgery is an outpatient procedure. After the surgery is completed, you will be able to return home immediately.
In one week, all sutures will be removed in the office. Depending on the nature of your work or daily activities, restrictions will be placed on various activities for one to three weeks.
If nasal surgery is involved, stitches may be necessary. However, these stitches will dissolve on their own a few weeks after a procedure is completed.
Surgical Side Effects
After migraine surgery, you may experience swelling and bruising around the eyes. However, these symptoms usually will disappear within one to two weeks. Ice, anti-bruising medication and ointment will be prescribed. There is also commonly itching that occurs near the scalp incisions that very quickly subsides.
Typically, there is minimal pain after surgery, and you will be prescribed pain medications immediately following treatment. You also may receive antibiotics to help minimize the risk of infection.
Migraine Surgery Concerns
Some of the most common migraine surgery concerns include:
- Scars do not heal properly
- Loss of hair around incisions
- Muscle/nerve injury that results in temporary movement problems
- Dryness around the eyes
In many instances, patients will experience temporary facial muscle weakness following migraine surgery. This issue usually disappears on its own in the weeks after treatment.
Depending on the trigger sites, patients may notice improvement immediately, but it may take weeks or months until the full effect is felt. The majority of patients notice improvement within two-to-four weeks.
Although uncommon, there is a chance your migraines will not significantly improve. This is usually related to additional trigger sites that are now noticeable after the removal of the primary sites, and can usually be treated with an additional procedure. It is very rare for there to be no improvement after surgery.
Why Choose The Migraine Institute For Your Migraine Surgery?
The Migraine Institute is the first center in Los Angeles that is exclusively committed to helping individuals eliminate migraine pain. We have a team of migraine specialists who are pioneers in the field of migraine surgery and will do whatever they can to assist patients. From the first moment you step into The Migraine Institute, our top priority is to take care of you so you can start enjoying life again!
Migraine Surgery FAQ
Is migraine surgery a form of brain surgery?
Minimally invasive migraine surgery is not a type of brain surgery. In fact, migraine surgery targets the migraine “trigger” nerves outside the brain.
Migraines may occur in the brain, but research also shows migraines often start outside the brain due to ongoing irritation of the sensory nerves around the face and neck. Thus, an individual may experience pain in the forehead, neck, eye or other areas of the face and neck before a full migraine occurs.
Do I need to stop taking medications prior to migraine surgery?
In most instances, a patient can continue to take his or her prescription medications throughout the migraine surgery process. The only medications that must be stopped are those that contain ibuprofen or aspirin, as these ingredients may increase a patient’s risk of bleeding.
Additionally, certain herbal supplements have been shown to increase an individual’s risk of bleeding. If a patient takes herbal supplements to treat migraine pain, Dr. Cabin may ask this individual to temporarily stop taking these medications.
It is important for a patient to provide Dr. Cabin with full details about his or her current medications prior to treatment. When it comes to migraine surgery, it is better to err on the side of caution. If a patient is unsure about whether a certain medication may affect his or her migraine surgery, ask Dr. Cabin for assistance prior to treatment, and he is happy to help.
Will I need to stay in a hospital following migraine surgery?
Migraine surgery patients generally do not require a hospital stay following surgery. However, in rare instances, patients may be required to stay overnight in a hospital if there is a concerning medical condition identified prior to the procedure.
Should I expect to see scars after migraine surgery?
Scarring may occur after migraine surgery, and the size and visibility of scarring will depend on the surgical site. Most post-surgical scars are invisible. In the case of the nose, there are no external incisions required during migraine surgery, which means patients won’t have to worry about scarring following treatment.
How long does it take Dr. Cabin to determine if an individual is a viable candidate for migraine surgery?
Dr. Cabin’s goal is to determine the best migraine treatment based on an individual and his or her migraine symptoms. To accomplish this goal, he allocates significant time and resources to evaluate different treatment options.
In many instances, it takes Dr. Cabin several weeks or months to determine if an individual is a viable candidate for migraine surgery and which trigger sites to treat. Also, Dr. Cabin often requests specialized testing to create a custom surgical plan tailored to a patient’s migraine symptoms.
How many trigger sites are treated during migraine surgery?
Dr. Cabin treats one to four sites during migraine surgery. The number of trigger sites treated during surgery varies from patient to patient.
How long does migraine surgery take to complete?
Migraine surgery is an outpatient procedure that requires about one to five hours to complete. Most patients return home the same day as surgery.
When will I see the final results of migraine surgery?
The final results of migraine surgery usually become transparent within a few days or months of treatment. In many cases, patients notice significant migraine improvements within about two to four weeks of surgery.
More Information on Migraine
How Frequently Do Migraines Occur?
Migraine prevalence is 14.7% globally, according to The Migraine Trust. In some instances, migraine sufferers receive over-the-counter (OTC), abortive, preventative and rescue medications and alternative or complementary therapies to address their migraine symptoms. However, in a recent National Migraine Foundation (NMF) survey of 3,900 migraine patients, only 40% said they were satisfied with their migraine treatment plan. For those who want to achieve long-lasting migraine pain relief, Dr. Cabin can help. In addition to identifying a patient’s anatomical migraine triggers, Dr. Cabin offers a personalized treatment plan to help each patient permanently address his or her migraine symptoms.
Pregnancy and Migraines: What You Need to Know
Pregnant women sometimes experience fatigue, nausea, constipation, mood swings and other physical symptoms. In certain instances, pregnant women experience migraines that cause debilitating pain, too. Natural treatments like applying a cold or warm compress to the forehead often help pregnant women alleviate their migraine symptoms. Of course, if migraine pain escalates during a pregnancy, it is always better to err on the side of caution. At this point, consulting with a doctor enables a pregnant woman to identify the root cause of her migraine pain, as well as determine the best course of action to resolve her migraine symptoms.
Common Migraine Triggers, and How to Treat Them
The caffeine in a cup of coffee, preservatives found in sausage and beef jerky, aged cheeses and even leftovers are among the “hidden” exposures that can trigger migraines in people worldwide. Yet much in the same way that no two individuals are exactly alike, migraine triggers vary from person to person. Fortunately, people who understand their migraine triggers can take the necessary steps to avoid these triggers. And for those who need assistance with migraine trigger identification and migraine treatment, a consultation with Dr. Cabin is ideal. Dr. Cabin is happy to help a migraine sufferer identify and treat his or her chronic migraine pain.
What Is the Link Between Smells, Detergents and Migraines?
Approximately 40% of migraine patients report strong odors trigger migraine attacks, according to recent research. Common odors that may cause migraine symptoms include car exhaust, cigarette smoke, paint thinner and perfume. There is no guarantee that one or more of the aforementioned odors will trigger migraine symptoms. However, for those who experience migraine pain due to strong odors, various migraine treatments are available. Dr. Cabin, for example, performs myriad tests to evaluate a patient and his or her migraine symptoms. He also helps a patient identify his or her migraine triggers and determine if minimally invasive migraine surgery or Botox can be used to address assorted migraine symptoms.
How to Respond to a Migraine Attack
Migraine attacks often occur without notice, and they may last from several hours to several days. Meanwhile, an individual who understands the four stages of a migraine – prodrome, aura, migraine and postdrome – is better equipped than others to alleviate his or her migraine symptoms. An individual may experience one, some or all of the aforementioned stages during a migraine attack, and as such, it is important to plan accordingly. Because if a migraine sufferer can identify the initial signs of a migraine attack, he or she can take the right steps to alleviate migraine pain before it escalates.