Migraine Surgery For Headache Trigger Points

There is an exciting development in the treatment of migraine headaches.

Migraine headaches affect over 10% of the population. While treatments have improved over recent years, there are still patients who either do not respond well or have undesirable side effects limiting the effectiveness of drug-based treatment.

This week, we performed what is likely the first migraine surgery in Canada, an endoscopic (minimal incision) release of the nerves to the forehead and central scalp.

Over the past twenty-five years research has shown nerve decompression surgery can be a very effective treatment for some migraine sufferers, much in the way carpal tunnel works to release compression of the median nerve to the hand.

When we started doing endoscopic forehead lifts in the mid-1990s, some patients reported their headaches had largely resolved. I had several of these patients, early in my experience with this procedure which I did quite commonly for cosmetic facial rejuvenation, either with or without a facelift.

But Bahman Guyuron, who was a plastic surgeon at the Cleveland Clinic in the 1990s (now in private practice) looked deeply into this, and initiated what became a series of studies of migraine and its treatment, with progressively more rigorous research. In paper after paper, he demonstrated how the release of compressive elements on the nerves supplying the scalp and face could alleviate the suffering of patients who were not otherwise helped. His research gradually led to more widespread acceptance, and now there are over fifty centres offering this kind of surgery, and many other research papers by other authors to corroborate his ground breaking work. The Migraine Surgery Society now holds annual courses and funds further research on the subject.

Since my initial experience with endobrow lifts, I have followed the continuing development of this exciting field closely. I have long wanted to bring this work to Canada but felt it needed cooperation from the neurological community. In December 2021, with the UBC division of Plastic Surgery, we held joint rounds (a forum for regular continuing education) with the UBC neurology service. Out of that came a cordial ongoing discussion with the aim to consider moving forward.

Several months ago, a local patient came to my Vancouver office independently for consultation. She told me she did not respond well to pharmaceutical measures and had read about surgery for migraine. I had her reviewed and assessed by the neurologist. We followed that with testing her by injecting her “trigger points” with local anaesthetics during a typical migraine affected day. Her headache disappeared, although only for the few hours the local anaesthetic was effective. However this was a positive test which meant I felt she would respond well to surgery.

We have now performed her surgery which involved endoscopic release of the affected nerves, via small incisions in her scalp. She is a month after her surgery and came in for a visit this week, wearing a broad smile; her headaches are dramatically improved.

To my knowledge this was the first surgery for migraine headaches ever done in Canada. This treatment is not for everyone. Most patients will be well treated and controlled with medication management, including Botox injections which may have a similar effect as the surgery. But Botox can be expensive if it needs to be done repeatedly over the years, and some patients it may not be effective. So surgery may be an appropriate treatment in certain patients, when all else has been tried.

If you have any questions about migraine surgery, our experienced and supportive staff at our Vancouver clinic is always available. Please call us at (604) 874-2078 or you can book your consultation today.

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