Does Migraine Surgery Work?

The Upside, Downside, and In Between

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If you are a migraineur who is resistant to conventional methods of migraine treatment, you and your headache specialist may have discussed migraine surgery.

Surgery is a big deal, though. It's a large undertaking with potential side effects, it's expensive, and it's still unproven.

Let's review one study on migraine surgery to see how successful (or not) it is. Regardless, please discuss any surgery you are considering with your primary care physician and neurologist.

Does Migraine Surgery Work?

One study in Plastic and Reconstructive Surgery examined 91 patients who underwent migraine surgery. Prior to surgery, the participants first underwent a botulinum toxin injection trial to confirm their migraine trigger sites.

The theory behind this type of surgery is that nerve compression in the head and neck is triggering migraines—so while botulinum toxin can temporarily ease the pain, surgical removal of a compressing structure (a muscle or nerve branch) would mimic the effects of botulinum, but be more long-term or permanent.

The four migraine trigger sites used for injection in this study included:

  • the forehead
  • temples
  • occipital region or back of the head
  • Intranasal (trigger point inside the nose)

In this study, the participants were followed after one and five years. The majority were women (average age of 43) and had a diagnosis of migraine without aura. After one year, 92 percent of the participants reported at least a 50 percent reduction in the frequency, duration, or intensity of their migraines.

Even better, nearly 35 percent noted a complete elimination of their migraines.

During the subsequent four years of follow-up, ten participants did not follow up, and ten participants were excluded from the study due to undergoing further surgeries for different migraine trigger sites. After five years, 88 percent of the remaining participants experienced a positive response to their initial and only migraine surgery, with 29 percent reporting complete elimination of their migraine headaches and 59 percent noting a significant decrease.

In this study, there was a control group of 25 participants (also with a diagnosis of migraine without aura) who received saline injections. However, they were not followed for five years. In fact, they were offered Botox injections after the one-year follow-up mark, which 17 participants agreed to undergo.

What do these results mean? Well, while it appears that a decent number of the participants received a benefit from the surgery, not a large percentage had complete elimination of their migraines.

There are problems with the study too. The control group was much smaller than the study group, and the participants in the control group did not undergo a sham surgery (placebo surgery or fake surgery)—there was also no comparison of the control group at the 5-year mark (which makes it more difficult to rule out a placebo effect).

Also, what about those ten participants that went on to receive additional surgeries—what does this imply about the benefit of their first surgery? It's also unclear what medications the participants were taking during this study, and how this played a role in their pain relief.

The Flip-side of Migraine Surgery

As surgery is an emerging intervention for migraines, you can expect some uncertainty. For one, there are side effects to surgery like nasal discharge or temporary dryness of the nose if the surgical site involves the inside of the nose. Scalp itching may occur if the surgical site is the forehead. Other side effects may include infection, discomfort, or temple hollowing with the injected botulinum toxin site.

A big concern is the placebo response of migraine surgery. A placebo response refers to a patient experiencing improvement in their symptoms (in this case their headache) from the psychological effect of undergoing a treatment (surgery in this case), rather than the treatment itself. The placebo response has been well documented in the medical literature and is a powerful phenomenon.

Overall, the sheer number of studies showing the positive evidence behind migraine surgery is low, making many doctors still cautious about recommending it to their patients.

A Word from Verywell

Undergoing migraine surgery is a time-consuming, expensive process that requires a careful evaluation of your diagnosis. As always, be patient, thorough, and proactive in your healthcare decisions.
 

Sources:

Diener HC, Schorn CF, Binge IU, Dodick DW. The importance of placebo in headache research. Cephalagia 2008;28(10):1003-11.

Guyuron B, Kriegler JS, Davis J, Amini SB. Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg 2005 Jan;115(1):1-9.

Guyuron B, Kriegler JS, Davis J, Amini SB. Five-year outcome of surgical treatment of migraine headaches. Plast Reconstr Surg 2011 Feb;127(2):603-8.

Mathew PG. A critical evaluation of migraine trigger site deactivation surgery. Headache.  2014 Jan;54(1):142-52.

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