It is important that anyone who is contemplating surgery for migraine needs to be under the care of a migraine headache specialist. The diagnosis of migraine should be established. Treating migraine specialists. Until the patient has the diagnosis of a migraine, it is unlikely that anybody we’ll come up with the treatment plan that has any chance of working. While plastic surgeons are highly trained physicians, there not trained medical migraine headache specialist. There are many reasons why people have migraine pain and surgery only address a small number of those patients. Current standard of care as treatment migraine with preventative and abortive medications as a first line of therapy. In fact, many patients improve from medication alone, and it is one medications don’t work that surgery may be considered as a treatment.
The first studies of nerve decompression surgery for migraine were done the patient’s him at the following criteria:
• Carried a diagnosis of chronic migraine.
• Failed medical management with traditional preventive and abortive therapy.
• Head triggerpoints which were identifiable reproducible on physical examination
• Had a positive response to Botox injection.
In this study with follow-up extending at least 5 years, the improvement rate was 88% and almost 1/3 of patients had complete elimination of headache symptoms at 5 years
Since that time, the solution criteria has changed and is more precise. Now we know that a group of signs and symptoms are as good as a trial Botox to predict who will or will not respond to surgical treatment. The revised set of symptoms are as follows:
Frontal Headache
• Pain above the brows
• Pain usually in the afternoon
• Strong corrugator muscles
• Tenderness at the supraorbital notch
• Unilateral eyelid drooping associated with headache
• “imploding” type of head pain
• Stress is a trigger
Temporal Headache (side of the head)
• Pain in the front part of the temple
• Tender temporalis or masseter muscle
• Pain common in the morning
• Wear on the teeth indicative of grinding
• “imploding” type of head pain
• Stress is a trigger
Occipital Headache (back of the head)
• Tender over the occipital nerves
• No specific time of pain onset
• History of whiplash or neck trauma
• Tight neck muscles
• Heavy exercise is a trigger
• Stress is a trigger
Rhinogenic Headache (nasal headache)
• Pain behind the eyes
• Awake with pain or pain in the evening
• Weather changes trigger pain
• Runny nose accompanies pain
• Pain can be related to seasonal allergies
• Pain is related to changes in menstrual cycle
• “exploding” character of pain
• CT scan findings of concha bullosa, septal bullosa, or septal/turbinate contact points
Migraine Surgery @ Landis Plastic Surgery 