Surgical Treatment for Migraines
Surgical treatment of migraine headachess involves elimination of various trigger sites, including nerves of sensation in the forehead, temples, and back of the head. In addition, there are triggers points inside the nose that can be addressed surgically as well.
The experienced plastic surgeons at University Hospitals use the latest surgical techniques to bring relief to patients who suffer from chronic migraine headache symptoms.
Migraine Headache Symptoms and DiagnosisTreatment
A neurologist makes the initial diagnosis of migraine headaches. Patients with presumed nasal or sinus migraine triggers typically have several symptoms, which can include:
- Headache pain behind the eyes
- Early morning headaches
- Weather headaches
- Allergy headaches
- Hormone or period headaches
- Runny nose
Patient History and Examination
When a nasal or sinus trigger is suspected, a physician with expertise in nasal/sinus-triggered migraines does the patient evaluation. Questions asked may include:
- How frequently does the headache occur?
- Where does the headache begin?
- What resolves the headache?
- How intense is the headache?
- Is the headache related to weather changes?
In addition, questions are asked about nasal symptoms such as congestion/obstruction, sinus issues, previous nasal surgery, nasal trauma, the use of various nasal sprays or medications, and whether or not a patient has allergies.
The doctor will examine the outside of the nose and feel it for characteristics such as tip support. The inside of the nose is then examined with a bright light and an instrument called a speculum that gently opens the nostrils so the doctor can see inside. Often a small flexible fiber optic telescope is placed into the nostrils to get a better view far into the nose, looking for any abnormalities.
If a computed tomography (CT) scan or magnetic resonance imaging (MRI) has already been performed, the physician reviews it. Relevant findings are discussed with the patient. If scans have not been done, they are ordered by the physician to better establish the relationship between sinus or nasal problems and the migraine symptoms.
Ideal Candidates for Migraine Headache Treatment
The best candidates for nasal/sinus surgery for migraine headache treatment are symptomatic patients who have a suspected relationship between headaches and structural or functional problems in the nose or sinuses. Ideal candidates are otherwise physically healthy, have realistic expectations, and are willing to accept the probability of success and the potential for complications.
Surgical Treatment for Migraines
Surgical treatment for migraine headaches is performed entirely through the nostrils and addresses the specific issues identified on physical exam or scans.
Each patient is different, and surgery may involve a procedure on the septum, the turbinates and/or the sinuses, including:
- Septum surgery
- Turbinate surgery
- Sinus surgery
The surgery is almost always done as outpatient unless a patient has other medical problems, and is usually performed with a general anesthetic.
The length of the procedure is highly variable depending on what is done in the nose. Typically, surgery for migraine headaches may take 15 minutes or up to an hour.