Nerve Decompression Surgery Provides Long-Term Relief for Frontal and Temporal Migraines

Nerve decompression surgery may help frontal and temporal migraines.A pulsating, throbbing pain engulfs your head like a vice grip, making every movement and thought feel agonizing. Even the softest light feels like a piercing glare, causing you to squint, shield your eyes, and seek refuge in darkened rooms. Ordinary noises, like the hum of a refrigerator or the clatter of cutlery, reverberate through your skull.

Fighting an ongoing battle with chronic migraines can leave you feeling as if your energy has been sapped away. Simple tasks become arduous. Sometimes, even the weight of your own body feels like a burden.

If chronic migraines have you longing for relief, you're not alone. Migraines affect over 35 million American adults per year, including 18 percent of women and six percent of men. Some of these individuals are able to manage their condition with medication and lifestyle modifications to avoid specific triggers, but millions of others find that migraine pain leaves them unable to work, spend time with loved ones, or enjoy their favorite hobbies.

Contrary to popular belief, migraine pain doesn't need to be a part of your daily routine. If conservative treatments have failed to keep your symptoms under control, you could be a good candidate for migraine headache surgical intervention. 

Nerve decompression surgery is a treatment option for migraine sufferers who have specific nerve compressions that are believed to contribute to their headaches. As a board-certified plastic surgeon with additional fellowship training in peripheral nerve surgery, Dr. Eric H. Williams has helped many migraine sufferers get the relief they deserve—and he may be able to do the same for you.

How Can Nerve Compression Trigger Migraine Symptoms?

Migraine sufferers are typically encouraged to look at diet, stress, weather changes, and hormonal fluctuations related to menstruation to determine headache triggers—and this works for most people with intermittent migraines. What they fail to realize, however, is that extracranial sensory branches of the trigeminal and cervical spinal nerves can be compressed, irritated, or entrapped in a way that results in migraine symptoms. Peripheral nerve irritation can occur spontaneously, but it can also be the result of posttraumatic or postoperative factors affecting peripheral nerves and surrounding tissue in the head and neck.

In peripheral nerves, myelin is vital for proper sensory and motor function because it forms a protective sheath around nerve fibers to allow for efficient transmission of electrical impulses. Damage or loss of myelin can lead to impaired nerve conduction, decreased sensation, muscle weakness, and other neurological symptoms. Through electron microscopy and proteomic analysis, researchers have found biostructural differences in peripheral nerve myelin from patients with migraines compared with peripheral nerve myelin from patients without migraines. This further supports the role of a peripheral mechanism in triggering migraine attacks.

How Does Nerve Decompression Surgery Provide Migraine Relief?

Nerve decompression surgery for migraines is typically performed under general anesthesia. In some cases, the operation is performed endoscopically or with the assistance of tiny instruments, which allows for smaller incisions and less visible scarring.

During migraine nerve surgery, a plastic and reconstructive surgeon locates the nerves suspected to be triggering the migraines and selectively decompresses the nerves or, in some cases, disrupts or removes them. The migraine headache trigger sites that will be targeted depend on the location of your pain.

Nerve Surgery to Treat Frontal Migraine Headaches

Frontal migraines involve pain and symptoms that are primarily localized in the frontal region of the head. This typically includes the forehead, temples, and areas above the eyes. The pain may be described as a dull ache or pressure, and it can be accompanied by symptoms such as sensitivity to light (photophobia), sound (phonophobia), and nausea.

Frontal migraines are often the result of compression or irritation of the supraorbital nerve and supratrochlear nerve branches of the ophthalmic division of the trigeminal nerve. These nerves play a crucial role in transmitting sensory information from the upper part of the face to the brain.

Nerve Surgery to Treat Temporal Migraine Headaches

Temporal migraines involve pain and symptoms that are focused on the temporal region of the head. The temporal region is located on the sides of the head, above and just in front of the ears. The pain associated with temporal migraines is often described as a throbbing or pulsating sensation, and it can be accompanied by additional symptoms such as scalp tenderness, difficulty concentrating, and visual disturbances (such as aura).

Temporal migraines are attributed to compression of the auriculotemporal and or zygomaticotemporal nerve branch of the maxillary divisions of the trigeminal nerve. The zygomaticotemporal nerve, along with other branches of the maxillary division, plays a role in transmitting sensory information from the lateral side of the head to the brain.

Who Is a Good Candidate for Migraine Surgery?

While each case is unique, three key factors may indicate you are a potential candidate for migraine surgery: severe chronic migraines, specific nerve-related migraine triggers, and failed response to conservative treatment.

Chronic Migraine Headaches

Candidates for nerve decompression migraine surgery have a documented medical history of chronic migraines that significantly impact their daily life. They also have undergone testing to rule out other underlying conditions that could be causing similar symptoms, such as tumors or aneurysms.  

Specific Nerve-Related Migraine Trigger Points

Typically, a person who is a strong candidate for surgical treatment has identifiable viable trigger points or nerves that are consistently involved in their migraine symptoms. This can be determined through diagnostic procedures such as nerve blocks or nerve stimulation tests. Often, the best candidates can point with a single finger to one or two of the "worst" areas of their head where the headache seems to start.  

Often, the headaches start in the same place every time. Patients might even press hard on these areas to try to "distract" themselves from the headache. Even if the headache includes the entire forehead region, the best candidates for surgical treatment can typically pinpoint the "bad actor."  When a patient is not able to pinpoint the location where the headaches starts, the results for this type of treatment are not nearly as impressive, and failure rates climb. 

Failed Response to Conservative Treatment Options

Nerve decompression migraine surgery is not recommended unless preventive and abortive migraine medications have failed to provide the desired headache relief. Candidates for this surgical procedure are chronically affected by symptoms such as severe headache pain, facial pain, nausea, and sensitivity to light or sound despite having tried a variety of treatment options.

How Effective Is Migraine Surgery?

The goal of nerve surgery for migraines is to provide a permanent solution for migraine relief by interrupting the nerve pathways that contribute to migraine attacks. Removing or decompressing these nerves may reduce or eliminate the frequency, duration, and severity of migraines.

There is significant evidence supporting the efficacy and safety of permanent surgical decompression of peripheral trigger points. It is estimated that the success rate of this surgery is near 90 percent in the ideal candidate. Success is defined as either complete elimination or a greater than 50 percent improvement in headache symptoms.

A 2014 review of the outcome of 17 published clinical trials found that peripheral nerve decompression surgery was a more effective treatment than long-term botulinum toxin type A (Botox) administration in patients with chronic migraine headaches. Surgical treatment resulted in experiencing either complete relief or greater than 90 percent improvement, while there was only a greater than 50 percent improvement in the botulinum toxin type A treatment group. Surgical treatment is also considered a permanent option for migraine pain, while Botox injections must be repeated every 12 weeks. 

In many cases, patients who undergo nerve decompression surgery no longer need daily preventative or abortive migraine medications. For example, one young woman we treated with a decompression of the right supraorbital nerve was able to fully resolve her frontal migraines within seven weeks. Prior to surgery, she was taking amitriptyline and Imitrex every single day to manage her headache pain. After surgery, she no longer needed either medication.

Additional benefits of nerve surgery for migraines include:

  • Improved daily functioning. Chronic migraines can significantly impact a person's ability to carry out daily activities, work, and engage in social interactions. By reducing the frequency and severity of migraines, nerve decompression surgery can enhance a person's ability to function more consistently and participate more fully in their personal and professional life.
  • Enhanced emotional well-being. Migraine headaches can have a substantial emotional impact, leading to anxiety, depression, and reduced overall well-being. By alleviating the burden of chronic migraines, nerve decompression surgery may improve emotional well-being.
  • Increased productivity. Migraines often result in missed workdays and decreased productivity. By reducing the frequency and severity of migraines, nerve decompression surgery can potentially improve work attendance, productivity, and job performance.

Take the First Step Towards a Pain-Free Future

Don't let debilitating migraine pain continue to steal your happiness, limit your experiences, and hold you back from the life you were meant to live. Imagine waking up to the gentle touch of sunlight on your face, basking in its warm glow without fearing the excruciating pain it once brought. Picture yourself strolling through a fragrant garden, inhaling the delicate scent of blooming flowers, and knowing it won't trigger a crippling headache. Envision engaging in conversations, laughter, and life's simple pleasures without constantly searching for a dimly lit corner to escape the unbearable light and sound.

With advanced migraine surgery techniques, Dr. Williams may be able to target the root cause of your frontal or temporal migraines—alleviating the burden that you've carried for far too long. Your journey to a life free from chronic migraines starts here, with The Dellon Institutes for Peripheral Nerve Surgery. If you would like more information or want to request your appointment with Dr. Eric H. Williams, simply call our office at (410) 709-3868 or fill out a contact form here

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.