Migraine Surgery
Surgical Options for Migraine and Persistent Headache Relief
Migraine and daily persistent headaches impact nearly 28 million Americans, often presenting with intense pain, nausea, light sensitivity, visual aura, appetite loss, dizziness, and fatigue. These symptoms can significantly disrupt daily life, affecting work, education, and personal relationships.
Nerve Involvement and Trigger Points
Migraines are often linked to nerve irritation at specific trigger zones: the forehead (frontal), temples (temporal), nasal region, and the back of the head (occipital).
Surgical Nerve Decompression
Migraine and headache surgery involves releasing pressure around these trigger points through a procedure known as nerve decompression. By relieving compression, these surgeries can reduce the frequency and severity of attacks. This approach typically has low complication rates and minimal recovery time.
Originally developed by Dr. Bahman Guyuron in the early 2000s, this technique has gained global recognition. Trained surgeons, often with backgrounds in plastic and peripheral nerve surgery, are able to identify and target these trigger areas. Clinical studies over the past decade show that approximately 85–92% of patients report a 50% or greater reduction in headache severity and frequency, with 50–60% experiencing complete resolution. Success depends on proper diagnosis and patient selection based on detailed neurological assessments.
A Measured Approach to Treatment
While outcomes can be transformative, surgery is typically considered only after conservative therapies have failed. Initial evaluation involves a neurologist or headache specialist who may use BOTOX®, nerve blocks, or imaging to locate trigger sites. Once identified, small incisions hidden in natural skin folds or hairlines allow the surgeon to decompress the involved nerves. In certain cases, tiny nerve branches may be resected if they are too damaged or compressed.
The Amirlak Technique
At UT Southwestern, Dr. Amirlak has advanced traditional decompression methods through a specialized approach that incorporates endoscopic visualization and precise arterial decompression. This method not only relieves pressure on nerves like the greater occipital nerve, but also addresses small arteries—often overlooked—potentially compressing these nerves. This technique has been presented at conferences and is being considered for peer-reviewed publication.
Types of Headache Based on Trigger Point
Pain starting above the eyebrows is treated by decompressing the supraorbital and supratrochlear nerves using an endoscopic technique, often similar to a cosmetic brow lift.
These result from entrapment of the zygomaticotemporal branch of the trigeminal nerve within the temporalis muscle. A segment of this nerve may be removed, leading to minor numbness in the temple, though other nerves compensate for sensation.
Pain behind the eyes may stem from internal nasal contact points. Surgical correction may involve septoplasty and turbinectomy to eliminate contact between the septum and turbinates.
Pain originating in the neck and lower head often involves the greater, lesser, and third occipital nerves. These nerves are decompressed through a combination of open and endoscopic methods, including removal of muscle segments and sometimes arterial ligation, followed by protective fat graft placement.
Questions?
Call 214-645-5560 or email us today to learn more about Migraine Surgery or to schedule a consultation.
