Surgical migraine therapy involves relieving pressure on various branches of the trigeminal nerve. In many people it is the interaction of the corrugator muscle and the trigeminal nerve that leads to a migraine attack. The corrugator is positioned above the eyebrows and is one of the muscles responsible for forming ‘frown lines’ or other expressions in that part of the face. Part of the trigeminal nerve passes through the corrugator muscle: as a consequence of irritation of the nerve, a cascade of events is initiated which can lead to a migraine attack.
The surgeon makes a small incision along the eyelid crease in order to remove the pain triggering muscle – in most cases the corrugator muscle. The nerve in the muscle is neither removed nor damaged in the procedure. By removing the muscle, the nerve in the trigger area above the eyebrow cannot be stimulated and therefore migraine symptoms are eliminated.
Trigger areas on the temples can be treated surgically by the same principle. Pressure is relieved on the corresponding nerve through keyhole surgery, with the surgeon accessing the nerve via the section of the temple that is covered by hair. The third possibility is to relieve pressure on a nerve located in the neck.
It is vitally important that each case is examined individually and that each patient undergoes a botulinum toxin (Botox) test before they are considered for the procedure. If migraine symptoms improve by more than 50 per cent in the first eight weeks after the injection of botulinum toxin, this is a positive, prognostic indicator for the success of the Migraine Procedure.
Over the years and as a result of the anatomical and clinical research studies, Dr. Guyuron has identified four very common and some uncommon trigger sites. He has developed surgical techniques to deactivate each of these trigger sites and alleviate the migraine headaches. His surgical techniques have been designed to cause the least amount of physiological change locally.
- FOREHEAD AREA In fact, in three sites, the surgery has some side benefits. For example, surgery for migraine headaches in the forehead area involves removal of the frowning muscles, which irritate two nerve branches on each side and cause forehead migraine headaches. In addition to stopping the migraine headaches, this surgery results in improvement in the forehead appearance by elimination of the frown lines.
- TEMPLE AREA In the temple area, the tissues are pulled sideways which results in a gentle lift of the eyebrows and causes rejuvenation of the temples. The surgery in the temple trigger site involves removal of a tiny branch of the trigeminal nerve that provides feeling to this site. This nerve has been detached for years for a variety of reasons including surgery around the eye socket and even cosmetic forehead procedures. Removal of this nerve may often cause temporary or rarely permanent numbness of the temple. Patients do not find the reduced sensation or loss of feeling in this area disturbing since this is not a highly sensitive area. In fact, removal of this nerve, which exits from the site in the temple that most patients commonly rub while having tension or migraine headaches, takes away or reduces migraine and other headaches.
- SEPTUM Another trigger site is the septum, the partition inside the nose that divides the interior nose into two spaces. The septum can have a varying degree of deviation. Also, enlargement of the projections inside the nose called the turbinate can be the source of migraine headaches. When there is contact between the turbinates and the deviated portion of the septum or the irregularities within the septum that are called spurs, migraine headaches can trigger After the surgery on the septum and turbinates, which includes straightening the septum and reduction of the size of the turbinates, not only do the patients observe improvement or elimination of the migraine headaches, they also experience improved breathing (the third example)
- BACK HEAD AREA The fourth most common site is the back of the head where several nerves can be the source of migraine headaches. The most common nerve involved in migraine headaches in this site is called the greater occipital nerve, which is a nerve that originates from the upper portion of the cervical spine (neck). The surrounding muscles or vessels can irritate this nerve. During the surgery, a small piece of muscle is removed from around the nerve and replaced with fatty tissues from underneath the skin to shield the nerve and separate it from the muscles so the chance of recurrence of the pain will be extremely remote. Additionally, this nerve is decompressed (released) in several sites along its course through the same incision. If the greater occipital nerve is irritated frequently, it can become chronically inflamed which is called occipital neuritis. The treatment is essentially the same.