Migraines are a persistent problem for millions of people around the world, yet a minority of individuals receive proper migraine diagnosis and treatment. As a result, many migraine sufferers unnecessarily experience the classic symptoms of migraines multiple times per month: severe throbbing or pulsating pain on one or both sides of the head that lingers between four and 72 hours. Additionally, a migraine sufferer may experience the associated symptoms of nausea and vomiting, as well as light and sound sensitivity.
If a person experiences any of these migraine symptoms, they should meet with a primary care doctor or neurologist – and if they are sufficiently severe, an emergency room visit is in order. By doing so, an individual may receive a migraine diagnosis. This diagnosis will likely be based on an individual’s medical and headache history, including questions about an individual’s diet, exercise and other lifestyle habits. A physical and neurological examination may also be performed.
After a migraine diagnosis is given, the doctor will likely move on to recommend and prescribe migraine treatments. Although there is no surefire treatment for all migraines, different types of medications may be prescribed to address migraines. These medications fall into three categories:
- Preventative: Help to reduce the frequency, severity and duration of migraines. Preventative medications may be taken on a regular basis.
- Abortive: Help to prevent or minimize a migraine at the onset. Abortive medications may be taken during an early stage of a migraine attack.
- Rescue: Help to treat active migraine symptoms, like pain and nausea. Rescue medications may be taken any time during a migraine attack.
Oftentimes, a trial-and-error approach to migraine medications is used, but this approach offers no guarantees. If a person receives a chronic migraine diagnosis from a neurologist and finds migraine medications fail to provide consistent pain relief or cause intolerable side effects, minimally invasive migraine surgery may be a excellent option.
What Is Migraine Surgery?
Although a migraine is related to changes in the brain, it can start outside the brain. In these cases, a trigger site sends a faulty signal to the brain, leading to a domino effect that ends in migraine pain inside the brain. Surgery treats these faulty nerve signals, reducing their ability to set off migraines.
Unlike medications, surgery permenantly addresses the anatomical trigger points of migraines to deliver long-term pain relief. These anatomical trigger points are:
- Forehead: Related to the supratrochlear and supraorbital nerves. This results in pain beginning from above the eye or on the forehead, either on one or both sides.
- Neck: Related to the greater occipital nerve, but also may involve the lesser occipital and third occipital nerves. This results in pain beginning on one or both sides of the back of the neck.
- Nose: Related to the many nerve branches within nose, leading to pain starting behind the eye, either on one side or both.
- Temples: Related to the zygomaticotemporal (ZMT) and auriculotemporal (ATN) nerves, causing pain to begin on one or both sides of the temples.
An individual may experience migraines due to one, some or all of the aforementioned triggers. Dr. Jonathan Cabin of The Migraine Institute understands will perform a comprehensive patient assessment to determine which trigger sites may be active for each individual patient. This begins prior to a consultation, as Dr. Cabin will request a detailed medical history that includes a migraine log. This information helps Dr. Cabin determine if an individual is a candidate for surgery.
In the office, Dr. Cabin will conduct extensive patient testing to customize surgery to an individual’s specific triggers. To further confirm migraine trigger site locations, Dr. Cabin may require one or more of the following tests:
- Nerve Block Injection: Blocks the signal transmission for a specific nerve. A nerve block injection helps Dr. Cabin determine whether a particular area is a trigger point, especially if a patient is actively in the early stage of a migraine when the injection is performed.
- Botox Injection: Relaxes the muscles around a nerve; Botox injections also have been shown to reduce or eliminates migraine symptoms over the months following injection, and can act similarly to a nerve block injection for trigger site location.
- Cat (CT) Scan: Involves the use of three-dimensional X-rays of the face and neck. A CT scan helps Dr. Cabin plan for certain surgical techniques, and also make sure there are not other non-migraine causes of a patient’s headaches.
- Doppler Ultrasound: Uses high-frequency soundwaves to locate an individual’s arteries and veins. With a Doppler ultrasound, Dr. Cabin may be able to identify areas where a blood vessel may be irritating trigger nerves.
- Nasal Spray: Requires the application of nasal spray through the nostrils to shrink the internal lining of the nose. Nasal spray may help reduce or eliminate migraines with a nasal trigger, and can serve as confirmation of a nasal trigger point.
If Dr. Cabin and a patient decide surgery is the best course of action, they will work together to develop a customized surgical plan. This strategy varies from patient to patient and may include one to four surgical sites.