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Surgeries and Other Procedures for Migraines

Medically Reviewed by Neha Pathak, MD on November 04, 2020

If you have migraines, the first things your doctor will likely recommend are medications, lifestyle changes, and other treatments that can do a lot to help. But if those methods aren’t enough and you get migraines often, your doctor may consider procedures to help reduce migraine pain.

Your doctor will review your medical history and your overall health to see what’s safe for you.

Botox for Migraines

Your doctor may suggest you get Botox shots to help prevent chronic migraines -- meaning that you have migraines on at least 15 days a month and they last for at least 4 hours.

While it has the same name, Botox for migraines isn’t a cosmetic procedure. If you choose to get this done, your doctor will give you 31 shots in your head and neck. Exactly how it helps prevent migraines isn’t clear, but in general, Botox temporarily paralyzes targeted muscles.

This isn’t a one-time treatment. People who get Botox shots for migraines usually have them every 12 weeks. It may take 2-4 weeks for it to start preventing migraines.

Neuromodulation

This procedure alters your nerve activity through electrical means or other medical methods. Neuromodulation directly treats the area of pain that causes your migraines.

There are different types of neuromodulation that focus on separate areas. All of them are either very mildly or not invasive at all:

  • External trigeminal nerve stimulation (eTNS)
  • Transcutaneous electrical nerve stimulation (TENS)
  • Transcranial magnetic stimulation (TMS)
  • Vagus (vagal) nerve stimulation (VNS)

Nerve Block

This is a temporary treatment and only for when a severe migraine strikes. Your doctor will inject a little bit of numbing medication into the base of your skull. This will block pain signals from your nerves. The effects of this procedure can last several weeks or months. You’ll get a nerve block as needed based on your pain.

Nerve Release

In some instances, migraines may happen because of a trapped nerve. If so, your doctor may suggest nerve release surgery. This option might include one or a few procedures. The number of operations you need depends on how many nerves are related to your pain.

This type of surgery is different for everyone. The overall process is usually shorter than most surgeries and has a low risk of harmful side effects.

Other Surgeries

In rare cases, your doctor may consider these procedures if they attribute your migraine to irritation from a deviated septum.

Septoplasty. Some migraines cause pain behind the eyes. This may be due to issues related to your nasal septum. Septoplasty, which is surgery to fix a deviated septum, can ease your head pain.

This procedure will straighten and shift your nose bone and cartilage between your two nostrils. Your doctor will give you anesthesia and then make a small cut in your nasal cavity. They’ll rearrange your septum and remove extra bone or cartilage that may cause your pain.

You’ll be able to go home the same day after surgery. Your doctor can take out the stitches or splints from a septoplasty a couple of days after the operation.

Turbinectomy. Your doctor may suggest a surgery that’s similar to a septoplasty to treat your migraine pain. During a turbinectomy, a doctor will take out some of the bone and soft tissue in your nasal passage.

Your doctor might suggest this surgery alongside a septoplasty or other operations.

How to Prepare for Migraine Surgery

Before you have surgery, your doctor may ask you to:

  • Stop smoking
  • Avoid certain medications like aspirin or other drugs that can make bleeding more likely
  • Get certain lab tests
  • Stop eating and drinking for a set time before your operation

You should plan to have someone drive you home after surgery. You may not be able to drive safely, especially if you had anesthesia. Ask a loved one to stay with you for the first night after surgery so they can check in on you and help as needed.

If you’re having a simple procedure in a doctor’s office, you won’t need to do the same level of preparation. When in doubt, ask your doctor.

Complications of Migraine Procedures

All procedures have risks. Ask your doctor about the risks and benefits of the procedure you’re considering. They’ll talk with you about what’s most likely, what’s not common, and answer any questions you have.

Some of the risks involved with migraine surgery include:

  • Bleeding
  • Infection
  • Problems with the healing of the surgical cuts
  • Bruising, scarring, and swelling in the affected area (usually temporary)
  • Hematoma, or when blood leaks form a torn vessel
  • Permanent numbness
  • Persistent pain
  • Seroma, or buildup of fluid

Recovery

Your recovery time will depend on the procedure you have. For instance, there may be no recovery time if you get a procedure like Botox in a doctor’s office. But if you need an operation, most people need a week or two after surgery to recover.

Your doctor will give you specific guidelines and may recommend that you not do anything strenuous for up to 3 weeks after surgery.

WebMD Medical Reference

Sources

SOURCES:

UT Southwestern Medical Center: “Migraine Surgery,” “Septoplasty.”

Medical University of South Carolina: “Migraine Surgery.”

American Society of Plastic Surgeons: “Migraine Surgery.”

University of Wisconsin Health: “Plastic and Reconstructive Surgery.”

Plastic and Reconstructive Surgery Global Open: “Causal Relation between Nerve Compression and Migraine Symptoms and the Therapeutic Role of Surgical Decompression.”

Gunderson Health System: “Headaches and Migraines.”

Vanderbilt University Medical Center: “Nerve Release for Migraine Sufferers.”

NYU Langone Health: “Nerve Block for Migraine in Adults.”

Jefferson Health: “Turbinectomy.”

Migraine Association of Ireland: “Other Treatment Options.”

Mayo Clinic: “General anesthesia.”

Cleveland Clinic: “Subdural Hematoma.”

Massachusetts General Hospital: “Migraine Surgery Program.”

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