Eighteen percent of women and six percent of men suffer from migraine headaches, making this potentially debilitating condition more common than asthma and diabetes combined. Patients often complain of nausea, visual disturbances, and incapacitating pain than can last for several days. The impact of these headaches on patients’ social, family, and work lives can be devastating.
Over 90% of patients who have migraine headache surgery experience an improvement in the number, length, and/or severity of their migraine symptoms. Approximately 35% of these patients experience complete relief of their migraines.
In 1999 one of Dr. Lowenstein’s mentors, Dr. Bahman Guyuron, discovered that some of his patients experienced relief from their migraine headaches following brow lift surgery. This revelation led Dr. Guyuron to investigate further to find that of 39 patients who had suffered migraines prior to their surgery, 31 experienced “significant improvement or elimination” of migraine headaches. The subsequent development of nerve decompression surgery (migraine surgery) has enabled many more patients to receive significant relief from their migraine headaches, and now Dr. Lowenstein is bringing these surgical techniques to Santa Barbara and the Central Coast of California.
Is surgery right for my migraine headaches?
If you have the following characteristics, you may be a candidate for migraine surgery:
- You have been diagnosed with chronic migraines by a neurologist
- You don’t feel that you have good control of your headaches
- You routinely have more than 2 migraine headaches per month
- You have tried multiple types of medications to treat and/or prevent migraine headaches
What can you expect from your care by Dr. Lowenstein?
During your first consultation, Dr. Lowenstein will review your history, your symptoms, and your current complaints regarding your migraine headaches. While not all migraine headache patients are candidates for surgery, Dr. Lowenstein will discuss the treatments you have received and additionally the use of local nerve blocks and Botox for temporary relief from your headaches. If you are experiencing a headache at the time of your consultation, Dr. Lowenstein may perform a nerve block at that time. If not, the use of Botox in the suspected trigger points (areas of compressed nerves) may be performed to see if this provides you long term, though temporary migraine improvement. Patients who respond favorably to nerve blocks or Botox injection are the best candidates for surgery.
Surgery for Migraine Headaches in Santa Barbara
Surgical nerve decompression for migraine headaches is performed in one of four regions of the head and neck. Importantly, all of these surgeries are performed as outpatient procedures under general anesthesia in our state of the art surgery center, and these surgeries do not involve surgery on the brain or skull bones.
For migraine headaches arising in the frontal or forehead regions, an incision is made in the upper eyelid similar to the incision used for aesthetic eyelid surgery. Through this incision, decompression of the supraorbital and supratrochlear nerves are released from their surrounding compressions. This surgery can be performed in conjunction with cosmetic improvement of the eyelids or brow, though this is not necessary.
For migraine headaches arising in the temple region, an incision can be made at or just behind the hairline allowing access to the zygomatiotemporal branch of the trigeminal nerve and the auriculotemporal nerve. These nerves provide sensation or feeling to very small areas of the temple and scalp, and removal of a segment of these nerves is very well tolerated, yet can provide excellent relief from migraine headaches arising in this area.
For migraine headaches arising in the occipital region in the back of the neck, small posterior neck incisions can be used to release the greater occipital, third occipital, and lesser occipital nerves from their surrounding constrictions. Up to six areas of compression have been identified for the occipital nerve alone, and decompression of this nerve can provide significant relief of headaches arising in this area, often initiated by exercise or stress.
Nasal migraine headaches feel like they arise in the front of the face or sinuses, and can be allergy related or worsened by certain weather conditions. These headaches are cause by compression of the nerves in the nose and can be improved by surgery on the nasal septum and reduction of enlarged turbinates (structures on the side of the nose that can swell and become chronically inflamed). Patients with nasal migraine headaches may require a CT scan to evaluate the nasal structures, and treatment of these headaches may involve the expertise of Dr. Lowenstein’s ENT specialist colleagues.