Suffering from migraines? Plastic surgery could offer relief

One in four households has at least one person who suffers from migraine headaches. If you don’t get them yourself, you likely know someone who gets these often-debilitating headaches — the condition is more common than asthma and diabetes combined.

It’s also the fifth-leading cause for emergency department visits nationally. When you have a migraine, you can become desperate for relief.

For many migraine suffers who try numerous treatment options and still don’t find relief, nerve decompression surgery is a potential solution.

What is nerve decompression surgery?

Nerve decompression surgery is a surgical procedure that addresses body structures like muscle, bone, fascia (tough tissue beneath the skin) and blood vessels that can compress, irritate or entrap peripheral nerves. It gives the nerves more room and relieves pain for the patient.

Plastic surgeons have been using nerve decompression surgery to address headaches since 2000. There are a growing number of surgeons who offer this to patients around the world, although I was one of the first, having started in 2002. I’m currently the only surgeon in central Ohio who offers this procedure to treat migraine headaches. The procedure has since accumulated more than 20 years of data to show that it significantly improves and, in some cases, eliminates headaches in more than 90% of the patients who undergo the surgery.

Plastic surgery is often associated with more cosmetic procedures, so some might be surprised to hear that it’s a viable treatment option for migraines and neuralgias (like occipital neuralgia). But plastic surgery encompasses a wide range of procedures that include aesthetic surgery, reconstructive surgery, specialized microsurgery, repairs for wounds, burns, nerve injuries and more.

Plastic surgeons have long been experts in nerve surgery, and through nerve decompression surgery in the head and neck, we can apply our expertise to a common problem for many worldwide. For some patients, this surgery is literally giving them their life back because migraines can be so debilitating.

How do I know if I’m a candidate for nerve decompression surgery?

1. You’ve tried more traditional, frontline treatments without success

I see a lot of what I call “kitchen-sink patients.” They’ve tried everything and the kitchen sink to get their migraines to go away. They’ve seen primary care providers and neurologists, they’ve tried medications, and nothing’s worked to their satisfaction.

It’s important to see a neurologist before seeking plastic surgery as a solution. There are many causes for headaches, and some other potential causes, such as tumors, should be ruled out before beginning the journey to nerve decompression surgery. I see patients only via referral from a board certified neurologist who has officially diagnosed chronic migraine headaches, supraorbital and/or occipital neuralgia, nummular headaches or post-traumatic neuralgia.

2. We’re able to identify nerve “trigger sites” to operate on

Once you’re referred to us by your neurologist, we begin learning about your condition through your medical paperwork and start pre-authorizing the tests that can help diagnose nerve trigger sites. It’s important that we do this homework so that we can get you started on the path to relief as soon as we see you.

Likely on your first visit, after we hear about your history and how your headaches have been affecting your life, you’ll undergo tests designed to determine if a particular nerve (or nerves) are responsible for your pain. This may include nerve blocks and/or Botox, in addition to other non-invasive tests. It may take more than one visit to determine whether you have trigger sites that can be addressed with surgery.

The most common areas for triggers are periorbital (around the eyes), in the temples and in the neck. They can also be in the scalp and nose/septum.

Each patient is treated like the individual that they are, so one patient’s plan may be different from another’s — every plan is customized to the patient.

What should I expect with nerve decompression surgery?

Nerve decompression surgery is designed as an outpatient procedure, and it’s performed under general anesthesia. If you have more than one trigger site, we can operate on multiple trigger nerves at once. Depending on the location of those nerves, we may divide the treatment into two separate surgeries, but most patients will have just one surgery.

This is a highly specialized surgery and typically lasts one to four hours, depending on the number of trigger sites.

Recovery typically takes four to six weeks, but it may take up to three months to determine success, as the results can be initially camouflaged by the natural inflammation caused by surgery. While there may be scars, as with any procedure, as a plastic surgeon, I try to make them as inconspicuous as possible.

As you recover, you’ll be asked to avoid lifting anything heavier than a gallon of milk and to avoid swimming, sweating or raising your blood pressure or heart rate, so that your body can heal. Because it’s normal to experience temporary sensation changes after surgery, you’ll be asked to avoid using heated hair devices such as a curling iron or having your hair chemically treated so that you don’t inadvertently hurt yourself.

The bottom line

Nerve decompression surgery isn’t the answer for everyone who suffers from headaches, but it can be enormously successful for appropriate candidates. It’s also not the same surgery in every person — everyone has their own individual trigger-site roadmap, and it’s my job to find out which nerve or nerves are the problem, then design procedures that will help that unique person.

Plastic surgeons who perform this surgery are collaborative partners with both their patients and with neurologists, all working together to relieve pain and improve lives.