Learn about nerve decompression surgery and how it can help treat migraine pain.
The benefits of migraine surgery were first discovered via the cosmetic procedure known as a brow lift. A brow lift decompresses the supraorbital nerves, which are above the eyes. Cosmetic surgeons were hearing from patients that their brow lift had stopped their migraine episodes. That discovery spurred extensive research into migraines and surgical treatments. Now, nerve decompression surgery is a treatment method for specific migraine patients who are candidates.
“Candidates for surgery are the patients who can localize a spot where their headaches start,” said Dr. Patrick Assi, a surgeon at Vanderbilt Plastic Surgery. People who have frequent episodes affecting their quality of life who have tried less invasive treatments without relief are also good candidates.
“It’s always a discussion with a multidisciplinary team,” Assi said. Vanderbilt’s team includes neurologists, neurosurgeons and pain specialists who work together to help patients.”
Migraine pain points treatable by migraine surgery
Some people with frequent migraines may notice they have pain that starts in the neck at the greater, lesser or third occipital nerve, and then that pain radiates to the front. Others may have pain that starts at one or both temples in the temporal nerves. And some people may experience pain right above their eye at the supraorbital nerves. Finally, some people’s pain comes from behind the eye, and they will have a contact point in their nose.
The pain may be from nerve compression caused by an encroaching vessel, bone or fascia. When an artery is the culprit, often the complaint is that pain increases during exercise or other instances when their heart rate rises. “The artery is hitting on this inflamed nerve,” Assi said.
Sometimes bone is to blame, as the supraorbital nerves come through a narrow formation. That tight space could be why the nerves are compressed. Fascia, which supports and shapes muscle, can also cause tightness and compression and irritate a nerve.
How to prepare for migraine surgery
Patients stay on their migraine medications until after surgery, and then they’ll work with their neurologist to be weaned off. Additionally, from the time of consultation up to about six months after surgery, patients are asked not to smoke and are placed on a diet protocol. The diet involves no caffeine, alcohol or preservatives – these substances can increase inflammation.
How does the migraine procedure work?
The success rate of migraine surgery is around 90%, “so a patient is either going to have a total resolution of their headache or a significant improvement. They get their life back.”
Migraine surgery is an outpatient procedure – there’s no overnight stay in the hospital. It takes 30 minutes to two hours, depending on the area being treated. The surgery does not operate on the brain, the spine or the eye.
If the migraine procedure is performed in the neck, scarring is minimal and hidden by the hair. The hair only needs to be shaved in a 1-inch section. If the surgery is performed on the supraorbital nerves, the scar will be in the upper eyelid, where it is well hidden after the incision heals.
If the surgery is performed on the temple, the incision is within the hairline. Some patients with pain behind the eye will require a nasal surgery, which Assi compared to rhinoplasty. In this procedure, the surgeon will decompress contact points within the nose and potentially repair a deviated septum.
Some patients have multiple pain points. For example, they may experience migraine pain in the neck as well as above the eye. The surgeon works on the neck first. About half of patients will then require a second procedure to decompress the nerves above their eye as well.
Overall, the success rate of migraine surgery is around 90%, Assi said. “So a patient is either going to have a total resolution of their headache or a significant improvement. They get their life back.”
More about Migraine Surgery
Migraines can have many causes. For some people, the trigger is compression or irritation of nerves in the head or neck. An outpatient surgery — no overnight stay in the hospital — can help decrease or get rid of chronic migraines for some people. Vanderbilt Health is the only program in the region offering this treatment for chronic migraines. For an appointment with these Vanderbilt experts, call 615-936-2700.
