28 million Americans suffer from migraine headaches. 18 percent of women suffer from migraines, which can be both severe and debilitating. Traditional migraine treatments have been either abortive (stopping the migraine once it begins), or preventative (taking daily or weekly medication to prevent migraines). However, one-third of migraine sufferers are not helped with conventional therapies. Encouraging new studies demonstrate that total elimination of migraine headaches through Botox and subsequent migraine surgery is a valid and safe option.
A History of Migraine Surgery and of Botox
Cosmetic Botox surgery has been around since the late 1980’s. Most people think of Botox injections as only for smoothing and rejuvenating wrinkles around the forehead. However, in the early 1990’s, two patients reported complete elimination of migraine headaches after they received Botox treatments. A retrospective study was then begun that looked at hundreds of patients who had undergone Botox treatments for cosmetic reasons. Of those patients who reported suffering from migraines and were questioned about the frequency and severity of their migraines after Botox, 82.8 percent were found to have a reduction in frequency of at least 50 percent, with an average follow up of almost 4 years.
Subsequent medical studies involved patients who were told to keep a headache diary recording dates, times, and pain levels of their migraines. The studies were created to help people who were suffering with extreme and frequent migraine headache symptoms. Therefore, patients whose migraines responded to more conventional medications were eliminated from the study. After migraine surgery, 55 percent of patients were able to report a complete elimination of migraine headaches. 28 percent reported a significant reduction of migraine headaches.
Since Botox injections are used as a diagnostic tool and do not cause any serious side effects, migraine surgery can often be recommended as treatment for patients with severe migraine symptoms who have tried many other traditional drug therapies.
What is a nerve block and how it is used to treat migraines?
What is a Nerve Block?
Traditionally, migraine headaches are thought to be caused by a condition in the brain itself or a neurological disorder. However, new studies done in recent years demonstrate that other areas in the head may be trigger points for migraine headaches. Increasingly, plastic surgeons are becoming important helpers for people who do not experience relief of their migraines after pursuing traditional remedies.
Success stories of migraine relief through injections of Botox have renewed an interest in finding other causes of migraine headaches. Four trigger sites have been found. One of these is along the course of the greater occipital nerve. The occipital nerve is found at the back of the head, above the neck. The greater occipital nerve has been described as piercing several muscles along its length. Any one of these intersections of nerve and muscle could serve as a source of compression or irritation of the nerve.
What is an Occipital Nerve Block?
An occipital nerve block is an injection of medication around the nerves that are located on the back of the head just above the neck area. The injection will reduce the inflammation of the muscle around the nerve. This in turn will reduce pain and irritation that can act as a trigger for migraine headaches. Typically, migraine headaches that originate over the back of the head will be best treated by an occipital nerve block. Usually the first injection is viewed as a diagnostic test rather than a treatment. The first nerve block will help define the trigger point of the migraine.
Talking to Your Physician
Before you choose a surgeon for your migraine treatment, meet with the surgeon. Ask questions about the procedure. Make sure you feel comfortable with the surgeon. Getting to know your surgeon will go far in assuaging fears, and you’ll feel better about choosing a surgeon who inspires confidence. Also, keeping a detailed headache journal will be valuable for when you speak with your physician. Record things such as times, dates, and the duration of your headaches. Keep track of symptoms and side effects of each migraine such as nausea, vomiting, aura or non-aura, and levels and placement of pain. Also note any migraine drugs taken, the amount of drugs used, and if these drugs were successful in reducing migraine pain. Being familiar with your migraines will help your surgeon to determine how to best help eliminate your migraines.
A Word about Migraine Headaches to Physicians
Physicians, this is a resource space especially for you as you determine whether to send your patients to us for an evaluation. Please do not hesitate to call or email us with your questions. We believe you will find the following research documents helpful in learning more about the science behind our treatments (available for instant PDF download):
Botulinum Toxin and Migraine Surgery
Having observed the safe use of botulinum toxin A (Botox; Allergan, Inc., Irvine, Calif.) in craniofacial patients for correction of strabismus byophthalmology colleagues… read more>>
Corrugator Supercilii Muscle Resection and Migraine Headaches
This study was conducted to determine whether there is an association between the removal of the corrugator supercilii muscle and the elimination or significant improvement of migraine headaches… read more>>
Posttraumatic Headache: Surgical Management of Supraorbital Neuralgia
Supraorbital neuralgia is a distinct clinical entity that presents with episodic, often unilateral, long-lasting attacks of moderate to severe frontal pain. This may ensue following a traumatic or surgical insult to the supraorbital or supratrochlear nerve…read more>>
The Lesser and Third Occipital Nerves and Migraine Headaches
Reports of a correlation between relief of migraine headaches and resection of corrugator muscles or injection of botulinum A toxin have renewed interest in finding the cause of migraine headaches and identifying the trigger sites…read more>>
Surgical Treatment of Migraine Headaches by Corrugator Muscle Resection
The authors, a plastic surgeon (Dirnberger) and a neurologist (Becker), conducted this study after reading the article by of Bahman Guyuron et al. in the August 2000 issue of Plastic and Reconstructive Surgery…read more>>
The Anatomy of the Greater Occipital Nerve: Implications for the Etiology of Migraine Headaches
An interest in pursuing new theories of the underlying etiology of migraine headaches has been sparked by previously published reports of an association between amelioration of migraine headache symptoms and corrugator resection during endoscopic brow lift…read more>>
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