The treatment of migraine headache patients by Botox injections has been shown to be effective in specific patients who have identifiable triggers of the supraorbital and supratrochlear, zygomaticotemporal, greater occipital, and septal trigeminal nerves. The temporary relief from Botox has led to the concept that relieving pressure on the nerves by muscle resection (surgical decompression) can subsequently be effective and may provide a more long-term solution to the migraine problem.
Surgical decompression of migraines has shown that a high percentage of carefully-chosen patients may benefit. (> 90%) On average, most migraine patients experienced improvement at one year follow-up, needing less medications for management. While some patients do experience a ‘cure’, this is not the majority. A recent publication in the July 2008 issue of the journal Plastic and Reconstructive Surgery confirms these results in their own reported experience. One of the most interesting findings of their study was that two-thirds of the patients felt that surgery offered better relief than Botox injections.
Surgical decompression involves removing muscle that intertwines or lays against the nerve. In the frontal area, this can be done endoscopically (like an endoscopic brow lift) or directly through an upper eyelid incision. As of now, this is a surgeon’s choice and the evidence that one method is superior over the other remains to be conclusively proven. For the zygomaticotemporal, greater occipital and septal trigeminal nerves, a direct open approach is used.
For those patients whose migraine headaches are of sufficient frequency and are not well controlled by medication, surgical decompression of trigger points offers potential for improving their lives.
Dr. Barry Eppley