Nerve Release Surgery for Migraine

Medically Reviewed by Melinda Ratini, MS, DO on May 15, 2024
4 min read

When you have migraine, it can be a long journey to find an acceptable treatment that provides relief. Some come with side effects you might not be able to live with. Or, you may not find a treatment that works at all. If your migraines aren’t responding to the options you’ve tried, you’re not alone.

Up to one-third of people in the U.S. who have migraine do not get relief from treatment. If you have a migraine disorder diagnosis from a neurologistand treatment doesn’t help, nerve decompression surgery may be an option for you.

What exactly is nerve decompression surgery? You may have heard it called “migraine surgery.” This procedure is an outpatient treatment that releases, or decompresses, the nerves directly under the skin that might be triggering your migraines. Nerve decompression surgery for migraines began in the mid-2000s and is still relatively new. But it has brought serious relief for a lot of people who didn’t benefit from other treatments.

Nerve decompression: A plastic surgery technique

Nerve decompression surgery, also known as nerve release surgery, uses a plastic surgery technique to address nerve-related migraine trigger points. Research into the surgery began when a few brow lift patients of Bahman Guyuron, MD, reported fewer migraine symptoms after their cosmetic procedure. According to the research, the release of a nerve behind the eye was what had provided the relief. Today, it’s still plastic surgeons who commonly perform nerve decompression surgery.

So, how exactly do nerves impact migraines? If you live with chronic migraines, you might take note of and monitor your triggers. These triggers can include caffeine, too little sleep, certain smells, and more. But irritated nerves can also be hidden triggers. Of course, you can’t manage a nerve trigger the way you could control a trigger like red wine, for example.

The nerves in your head or neck just below your skin can become compressed. Surrounding tissue, muscles, and even blood vessels can squeeze them. Without enough space, these constricted nerves may trigger migraines.

Nerve decompression surgery removes the tissues or blood vessels that are pressing on, constricting, or irritating those nerves. Don’t worry, the surgery never removes skull bones. Once the nerves have more space, the surgeon adds extra padding made of fat to each nerve as added prevention against migraines.

Unlike pills that you may take every day to prevent migraines, this potentially one-and-done surgery may stop them for good.

If you want this surgery, you need a migraine disorder diagnosis. If you have migraines that don’t respond to treatment, you may already have a migraine diagnosis. You could also be a candidate for this surgery if negative side effects from migraine medications prevent you from taking them.

Before the surgery, some doctors may want you to track your migraines with a log or provide background on the severity of your migraines and on your previous treatments and their side effects. This is because the surgery is best for patients with migraines that do not respond to other treatments, therapies, or preventive measures. So, your migraine history can help determine if this surgery will help you.

If you just started having migraines, or if you’ve never seen a doctor about your migraines, you probably aren’t a candidate for surgery yet. You will need a diagnosis, and you’ll probably need to try other treatments before looking into surgery.

Before the surgery, your surgeon will need to locate trigger points that the irritated nerves cause. The doctor may use anesthetic or Botox injections in this process. After the injections, you may experience relief from migraine symptoms. This is a good sign that the surgery will be effective. It also confirms the location of your unique trigger points.

The surgery usually takes between 1 and 4 hours. The doctor may give you general anesthesia so that you will be unconscious for the entire procedure. Next, the surgeon will make small incisions in your upper eyelid or the front or back of the scalp, depending on where the offending nerve is. Sometimes, nasal nerves are the constricted trigger points because you have a deviated septum (misalignment of the wall between your nostrils). In this case, you may get a surgery called a septoplasty to repair the septum, which can release the nasal nerves.

The procedure is usually outpatient, but you may need to spend one night at the hospital. Overall, the incisions are extremely discrete. The treatment may even reduce the appearance of lines and wrinkles due to the nature of the surgery.

Once you’re home, you can start showering after 2 days. You can restart your normal work routine in 2 weeks or less, depending on what you do for a living. Some doctors may ask you to wait up to 3 weeks before lifting heavy items or doing certain other activities. During that time, and up to a year after, you may have multiple follow-ups with your physician.

While you’re healing, you may notice:

  • Bruising
  • Numbness
  • Soreness
  • Tingling
  • Itching
  • Swelling
  • An occasional migraine

These symptoms are typically temporary, and you can ask your doctor about them at your follow-ups.

Other than short-term side effects, this surgery has a few possible complications, including hair loss and nerve injury. There’s also a chance that your migraines don’t fully disappear after surgery. That’s because decompressing a few of the trigger points may reveal more that was previously hidden. You might need to try additional Botox injections or another surgery for these trigger points.

Whether or not you need additional procedures, you still may experience migraine relief that other treatments couldn’t provide. In one study, a year after patients received nerve decompression surgery, 57% said their migraines were completely gone.

For many people, it is a permanent migraine treatment that provides complete relief.