What is Migraine Surgery?

What to Expect and the Controversy Behind Migraine Surgery

Migraine Surgery as a Controversial Therapy
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Traditionally, treatment of migraines focuses on behavioral interventions, such as trigger avoidance and pharmacological or drug treatments. While these measures work for some individuals, others are resistant to these conventional methods of care. In other instances, patients may benefit from a preventive or abortive medication, but the side effects outweigh their benefit. In these instances, one may consider a more aggressive treatment, such as migraine surgery.

Please note that migraine surgery is a newer treatment for migraines and typically involves relieving pressure on the nerves thought to be responsible for your head pain. It's a controversial procedure and is really an unproven method of migraine therapy at this time. More studies proving its benefit need to be completed.

That being said, let us review the process one may undergo if choosing migraine surgery in the future.

What to Expect Before Migraine Surgery

Before undergoing migraine surgery, patients are carefully screened to make sure their diagnosis of migraine is correct. This assessment is typically done by a neurologist, using criteria proposed by the International Headache Society. In addition, patients are often asked questions about the impact their migraines have on their quality of life and level of disability, as surgery is a major undertaking and something that needs to be thoughtfully considered.

There are different types of migraine surgery, but recently the focus of surgery has been on trigger site release. In this type of surgery, nerves around the skull are decompressed or relieved of pressure. This may involve removing part of a muscle of the face, so that the nerve cannot penetrate it anymore.

The skull is not broken, and there is no surgery done on the brain.

Once patients are screened appropriately, they often, (but not always) undergo a botulinum toxin trial in which various trigger sites in the head are injected. Botulinum toxin, known by the trade name Botox, is a toxin produced by the bacteria Clostridium botulinum and works by blocking nerve connections, which decreases muscle activity. It was approved in October 2010 by the FDA for treatment of chronic migraine.In terms of its use for a surgical intervention, botulinum is used as a test to see if surgery would be a more successful, long-term solution. Typical trigger sites used for injection include:

• the forehead

• temples

• occipital region or back of the head

• Intranasal (trigger point inside the nose)

If the patient notes a significant improvement, than surgical management of that trigger site is considered.

What to Expect During Migraine Surgery

Depending on the trigger site, there are different surgical techniques used.

The basic idea involves decompressing the nerves thought to be responsible for the migraine. Sometimes this involves removing a muscle group of the face or a part of the trigeminal nerve.  The big picture here is that the actual surgery varies based on the nerve and/or muscle group thought to be the cause of someone’s head pain during a migraine.

What to Expect After Migraine Surgery

After surgery, you will follow up with your doctor to evaluate your response rate. Some of you may notice a reduction in the frequency, duration, and/or intensity of your migraines. Some may even have elimination of their migraines and others may notice nothing. It's difficult to say at this point, as the long-term evidence of migraine surgery is limited. There are also potential site effects to migraine surgery like itching or infection -- these need to be carefully addressed prior to surgery.

Important Take Home Points

• Surgery is a big deal and something that must be carefully considered. Please note that surgery for migraines is still a novel and rather controversial procedure. It's benefit remains unproven. A detailed discussion about the potential side effects of surgery and the expected outcome of the surgery needs to be reviewed thoroughly with your headache specialist and surgeon.
• Only future studies will tell us whether this is a viable option for migraineurs. Regardless, please seek out the guidance of a headache specialist if you are suffering from migraines that are not better with usual medications or treatments. There are lots of therapy options out there that are less expensive and less invasive.


Kung, T.A., Guyuron, B., & Cederna, P.S. (2011). Migraine Surgery: a plastic surgery solution for refractory migraine headache. Plastic and Reconstructive Surgery, 127(1):181-9.

Lipton, R.B., Bigal, M.E., & Diamond M, et al. (2007). Migraine prevalence, disease burden, and the need for preventive therapy. Neurology, 68(5):343-9.

Totonchi, A., Pashmini, N., Guyuron, B. (2005). The zygomaticotemporal branch of the trigeminal nerve: an anatomical study. Plastic and Reconstructive Surgery, 115(1):273-7.

DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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