Migraine Headache Surgery

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. Visit Dr. Lowenstein’s Headache Surgery Website… Headachesurgery.com

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.

FAQs: Migraine Surgery

  • What are migraine headaches?

    Migraine headaches are often severe headaches that can have debilitating symptoms including severe pain, visual disturbances, nausea and vomiting, and exhaustion. Migraine headaches are best diagnosed by a neurologist and are a different entity than normal headaches which are usually much less severe. Migraine headaches may be disruptive to your lifestyle, your work, your family, and your social life

  • Who gets migraine headaches?

    Migraine headaches are more common than previously thought. Nearly one in every five women experience problems with migraine headaches, though men can also be subject to migraines. In fact, Dr. Lowenstein is one of the six percent of men who have had migraine headaches all of his life, and treatment of his migraines has had an amazing impact on his life. This is one of the principle reasons that Dr. Lowenstein is so interested in brining migraine surgery to Santa Barbara.

  • How are migraine headaches treated?

    Migraine headaches can be treated with drugs, Botox, surgery, or alternative therapies. Some patients have found success with therapies such as acupuncture. The usual medications that are used to try abort a headache (treat an active headache) include triptans (Maxalt, Imitrex, Zomig, Amerge, Axert, Frova, Replax), ergots such as DHE, Midrin, narcotics, and barbiturates. Botox was approved by the FDA for the treatment of migraine headaches in adults, and can be used in either a multiple injection technique around the head, or in a nerve target technique. When a nerve target technique is use and Botox treatment is seen to be effective, migraine surgery can often be utilized to create the same relief on a longer term basis.

  • How can migraine headaches be prevented?

    Prevention of migraine headaches is often attempted with various drugs including beta blockers, calcium channel blockers, anti-seizure drugs, anti-depressants, and blood pressure medications such as ACE inhibitors. When effective, these therapies may preclude the need for surgery and be an excellent option. Surgery is usually reserved for patients in whom these drugs have not been effective.

  • Am I a candidate for migraine headache surgery?

    Candidates for migraine surgery have been diagnosed by a neurologist, have found drug or alternative therapies ineffective, have more than two headaches each month, and find their headaches to have a major effect on their lives.

  • What are the risks of migraine surgery?

    Complications of migraine surgery are most often minor and temporary, including numbness and incomplete migraine relief as well as nerve injury, bleeding, and wound healing problems (as are risks in any type of surgery).

  • How effective is migraine surgery?

    Both retrospective studies (studies looking back in time) and prospective studies (studies performed in real-time) have shown excellent success rates for migraine surgery. Success for this surgery is defined as complete elimination of migraine symptoms or more than 50% decrease in the symptoms associated with migration headaches. These studies have shown that surgery success rates vary between 70% and 90% with roughly 30% of patients finding total relief of their migraine headaches. Recently published five year followup studies have shown that these results are persistent.