Migraine sufferers know that living with the pain caused by these excruciating headaches can be debilitating. To make matters worse, many people struggle to get through a migraine attack—and the nausea, vision problems and other accompanying symptoms—because medication doesn’t help alleviate the pain. However, they may find relief through migraine surgery, states Dr. Jonathan Cabin of The Migraine Institute.
The first step someone should take in order to pursue this option is to make sure they are a good candidate for surgery, Dr. Cabin says. “Patients must have an official migraine diagnosis from a neurologist and have an insufficient response to migraine medication, or intolerable side effects.” He adds that during the initial work up at The Migraine Institute, the patient must have at least one of four discrete anatomical trigger site, which will be deactivated during surgery. The four trigger sites are: the forehead, temples, nose and the back of the neck.
If the patient meets the criteria, the road to migraine surgery begins in the clinic. A thorough work-up—including a medical history and physical exam—is used to find any sensory triggers that can be causing migraines, Dr. Cabin says. Specialized testing, such as CT scans or a Doppler ultrasound, may also be part of the evaluation process.
“Although migraines occur within the brain itself, they are frequently triggered outside the brain by certain sensory nerves. By finding and deactivating these trigger sites, migraine frequency, duration and intensity can decrease,” he remarks. “Sensory nerves are deactivated by separating them from surrounding tissue that may be compressing these nerves or, in certain cases, cutting the responsible nerve or nerves.”
Patients at The Migraine Institute are well-prepped before surgery; the procedure is discussed in great detail during preoperative visits. Each patient has a customized surgical plan and patients follow the guidance of their doctors when it comes to medication. Generally, patients stop taking any medications that can increase bleeding, but they can continue with most migraine medications. As with many operations, patients who undergo migraine surgery are asked to abstain from eating or drinking anything starting at midnight the night before the procedure. Most migraine surgeries are done on an outpatient basis.
Once the surgery is complete, usually anywhere from one to five hours, the recovery period begins, although that may mean different things to different people, Dr. Cabin says. “If there is any pain and discomfort, it is usually only in the first few days after surgery. As such, patients are generally able to go back to work a few days after the surgery, but will sometimes take off more time, up to two weeks, to recover comfortably,” he states. “If there are drains, they are usually removed three to four days after surgery.”
Dr. Cabin adds that swelling, bruising and skin changes are usually gone within one to two weeks after the surgery and heavy lifting and strenuous activity can usually resume after three to four weeks. Most scars are invisible. “A patient should experience a decrease in the frequency, duration and intensity of migraines starting about six weeks after surgery,” Dr. Cabin says.
For migraine patients today, there are many treatment options—including lifestyle changes, alternative treatments, Botox and medications—but surgery is worth exploring to see if it’s suitable for patients and their migraine relief. “In the correct patient with sensory triggers, it can be a very powerful and lasting treatment,” Dr. Cabin comments.