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Plastic Surgeons Treating Migraine Headaches

By Brian Kobienia, MD, FACS on May 07, 2013


 

 

Migraine headaches are a major source of misery to those who suffer from them but also are a major loss of productivity in the workplace.  

 

Over 30 million people suffer from migraines.  Women are three times as likely to have migraine headaches than men. Symptoms include pulsating pain on one or both sides of the head are most common.  Physical activity may intensify the pain.  Some people may find that exposure to light, smells or noise may make their symptoms worse.  Some patients have an aura.   A common aura is flickering lights, spots, or wavy lines.  Sudden change in mood without reason may be associated with migraines.  Sleep disturbances occur in migraine sufferers.  Whether lack of sleep leads to migraines or migraines lead to sleep disruption has yet to be determined.  Sinus like symptoms, stuffiness, nasal drainage, eye pain and droopy eyelids are not unusual symptoms.  Frequent urination, yawning and numbness on one side of the body may be other symptoms that a migraine is imminent.  Physical symptoms including nausea or vomiting, blurred or double vision and vertigo are often reported.

 

There are several different types of headaches: tension, cluster, sinus, rebound and migraine.  Tension headaches are the most common and typically center around the temples, or back of head and are described as constant and not pulsating. These headaches will respond to over the counter medications.  Cluster headaches are more common in men, are quite debilitating, and have physical symptoms like watery eyes. Sinus headaches are associated with infections of the frontal and maxillary sinuses.  Rebound headaches occur ironically after stopping chronic use of painkillers aimed to ease headache symptoms.  And migraine which are quite painful and debilitating.

 

Statistics

 

In the United States 37 million people suffer from migraines. Some studies suggest 13 million adults have migraines and 2-3 million are chronic sufferers. Almost 5 million Americans get migraines monthly and 11 million report disability from their migraines.

 

Treatment

 

Treatments include getting enough sleep, rest in the dark, ice packs, diet (make sure you get your caffeine), spicy food (capsaicin is a painkiller), taking riboflavin, and acupuncture.  If those treatments are unsuccessful medications like maxalt and immitrex may be useful.

 

Surgical Treatment for Migraines

 

Recent studies suggest that there may be anatomic causes for migraines.  Entrapment of the supratrochlear and supraorbital nerves has been suggested as a cause.  Impingement of these nerves either by a fibrous band or a tight foramen (exit hole in the skull) or pressure from the muscles they travel in are causes of migraines.  Migraine surgery centers around releasing the fibrous bands placing pressure on the the nerves, or debulking the muscles.  Chemical atrophy of the muscles with Botox can be a treatment to weaken the function of the corrugators and procerus muscles (the muscles the offending nerves travel through).  Botox treatment should be tried prior to surgical treatment.  In the extreme patient where easier treatments have failed surgery may be and option.

 

The surgery is designed based on a patients trigger points.  Access to the nerves affected is done through an upper eyelid incision or a hairline incision.  The popularity of these operations has increased and recently even had insurance companies cover the procedures as medically necessary.  The surgery is typically an outpatient procedure and should have only a several day recovery time.  

 

If you have suffered from migraines for years and have exhausted conventional treatments maybe its time to explore surgical options!

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