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At first glance, migraine headaches does not seem like a plastic surgery topic. Most people see their primary doctors or a neurologist or some women even have their gynecologist treat their migraines. The surgical treatment is only about 10 years old and has been developed by plastic surgeons. Lets look at the evolution of migraine treatment and the development of surgical procedures that often can totally cure migraines.
Botox was originally approved by the FDA for muscle spasm around the eyes and uncontrolled sweating. The cosmetic use was discovered in the late 1980's and became one of the most popular rejuvenation techniques. With so many women using Botox, reports soon surfaced that the incidence of migraines decreased significantly. Further study confirmed that Botox was a useful treatment for migraines and the FDA approved it a few years ago.
About a decade ago. plastic surgeons who did cosmetic brow lift procedures reported a drop in migraine incidence - similar to the decrease noted in Botox use. Some very bright plastic surgeons put these findings together and through a lot of careful research came up with a novel explanation of the cause of most migraines as the compression of nerves at specific trigger points. Surgical treatments were then developed.
There are four common sites of nerve compression that can cause migraines (as well as a few less common sites). The most common site is over the temples where a small nerve that gives sensation to the skin above the temples pokes right through the muscles of the temple. The second most common is near the middle of the forehead where nerves poke through the scowling muscles. The third actually comes from problems in the nose such as a deviated septum where the nerves are irritated at contact points. Nasal problems produce the stabbing pain behind the eyes. The last of the common sites is at the back of the head where the muscles of the neck attach.
Most of the time, all that is needed is to find the compressed nerves and release them. By relieveing the pressure, the migraine pain is usually eliminated or reduced significantly. The results last - with some 5 years studies showing stable improvement.
After calling for an appointment, patients will be sent a headache log and a questionnaire. In order to accurately verify the severity and type of headache, a 30 day log must be kept. Also, each patient will have to be seen by a neurologist if they have not seen one on their own already. Most patients will have to have tried at least two classes of medication (If medication works, there is no need for surgery).
Next, a trial of Botox is done to make sure that symptoms resolve. Depending on the results of the headache log, a maximum of 6 injections is given. Also, a CT scan of the nasal sinuses is usually done to rule out any probems in the nose. No surgeon wants to have to take someone back to the operating room for a missed site, so everything is investigated before the surgery. Once the diagnosis is confirmed and all problems clearly laid out, surgery is planned.
Once the planning is done and the patient is ready, the surgery is scheduled. The surgery usually takes about 3 hours but can be longer or shorter depending on how many sites must be released and if any nasal work is needed. Also, some patients request cosmetic surgery at the same time and this can increase the duration of the surgery. This is typically an outpatient procedure but if several sites are released then you are welcome to spend the night in the hospital. Moms with younger children and needy husbands often want to stay overnight.
Recovery is fairly rapid. Patients can expect to have a couple of migraines in the immediate post op period since the nerves have been irritated by the surgery. The first office visit is usually 3 to 5 days after surgery. Normal activity can be resumed at 3 weeks without restriction. Residual swelling resolves quickly but is totally gone in about 2 months.
If you would like more information, please check out my blog post for information on migraine surgery.
There is much to discuss so if you are thinking getting rid of your migraines, lets go through the steps: