Migraines can be a real headache… Luckily, Dr. Hamawy is one of just a few surgeons in the United States who performs migraine surgery. No need to suffer any longer; there is now an effective, lasting solution. If you are in the North East and suffer from sparse or chronic migraines, contact our office today. We look forward to helping you on the road to relief.
Migraine versus Tension Headache
Head pain is unfortunately all too common. The head actually experiences pain more commonly than most other parts of the body. The pain can range from occurring in just one spot to the entire head.
Headaches can be triggered by different factors, but most commonly from overactivity or irritation of muscles, nerves, and blood vessels. Headaches caused by the aforementioned are considered primary headaches, meaning they are not caused by other sources such as meningitis or internal bleeding; these are considered secondary headaches. Other causes of primary headaches include:
- Lack of sleep
- Specific foods
- Missing meals
There are two main types of primary headaches: tension headaches and migraines. Tension headaches are steady, non-pulsating pressure on the sides of the head; they are not accompanied by other symptoms. The feeling is similar to a tight band around the head.
Migraines on the other hand present as pulsating pressure, accompanied with sensitivity to light and sound, blurred vision, dizziness, and nausea. While headaches are usually mild to moderately painful, migraines are moderate to severe.
Migraine headaches affect up to 20% of the US population and can dramatically interfere with work, school, family events and all other aspects of a person’s life. Many patients are able to control their migraines with medications. However, there are many who continue to have attacks despite being on any medical treatment. These patients spend years seeing different doctors and trying numerous medications without success. Attacks can be set off by certain foods, smells, hormonal fluctuations, or stress. In some patients nothing specific can be found.
Some men and women are able to tell if a migraine is coming before it happens. This is considered a migraine with aura. The word ‘aura’ is in reference to preliminary sensations. These can include seeing flashes of light, numbness and tingling, food tasting different, or trouble clearly thinking. Migraines without aura are randomly oncoming migraines with no bodily warning.
About Migraine Surgery
Previously, the only way to remedy migraines was pain medication or Botox injections. Now, when other remedies have been exhausted, migraine surgery is an option.
Recent medical evidence has shown that in some patients migraines are caused by the irritation of certain nerves in the head and neck. The muscles that surround these nerves usually cause this irritation which lead to a full-blown migraine attack. These nerves are located in well-defined areas and are divided into trigger points depending on where the headaches usually start: the frontal, temporal, occipital, and nasal trigger points.
Migraine surgery works by releasing the pressure on these trigger points after we have identified them, and preventing the migraine from starting, or at least making them occur less often and with less intensity. This is a minimally invasive approach; there is no skull or brain drilling. By performing migraine surgery, frequency, duration, and severity of the migraines are greatly reduced, if not eliminated altogether.
Surgery does not always provide an absolute cure for the migraines, although it does in some cases. In most people, it dramatically improves the attacks, in frequency, intensity and duration so that patients can resume a normal life without being debilitated every time they get the headaches.
How was Migraine Surgery Discovered?
In the late 1900’s, it was reported by multiple patients of Dr. Guyuron who underwent brow lift surgery that their headaches and migraines significantly decreased if not disappeared. It was after these cumulative discoveries that the idea of surgically relieving nerve inflammation leading to decreased headaches was established, and thus the concept of migraine surgery was born.
You must first confirm with a neurologist that your head pain is indeed migraines and not tension headaches.
If confirmed, you may be a candidate for migraine surgery if you have tried remedies such as homeopathic or over the counter medications, change in diet, and change in lifestyle but with no prevail. The aforementioned attempts may temporarily resolve the pain, but migraines continue to hinder everyday tasks. This is because migraines are caused by an underlying condition which cannot be fully remedied by non-surgical means. However, it is important that you try all non-surgical options before considering migraine surgery; surgery should be the last option. Dr. Hamawy asks that you keep a “migraine diary” and track migraine frequency, duration, and severity.
Migraines are most commonly experienced in women between the ages of 25-50 years old, but both men and women of all ages will be considered.
You must be in good health and have realistic expectations of the surgical outcome. The surgery will not guarantee the disappearance of migraines completely, but experience and studies have shown this to happen for some patients. At the time of the consultation, Dr. Hamawy will review your migraine records, your medical history, and perform certain tests and scans to see if you qualify for migraine surgery.
If you have been diagnosed with migraine headaches by a neurologist, have tried medical therapy without success and have at least two migraine headaches per week, consider having migraine surgery in Princeton, New Jersey with Dr. Adam Hamawy. Dr. Hamawy is a cosmetic and reconstructive surgeon with extensive experience performing this surgery and has helped many patients eliminate migraines from their life. He is certified by the American Board of Plastic Surgery and the American Board of Surgery.
Your first visit with Dr. Hamawy will determine if you are a candidate for surgery. During this visit, Dr. Hamawy will ask you about your migraines and confirm if you are a good candidate. Be prepared to discuss all your prior migraine therapy as well as any other medical conditions you may have including allergies, prior surgeries and medications, vitamins or other supplements that you currently take. It is important for you to provide complete information.
Once it is confirmed that you are a good candidate, the muscles around the suspected areas will be injected in-office with BOTOX® or local anesthesia to paralyze them and keep them from irritating the nerves.
You will be asked to follow up in four weeks. During this time it is important to continue maintaining and recording a headache log. If after the four weeks you have significant improvement, then surgery has a high likelihood of being successful and surgery will be scheduled.
If no improvement is noted, then unfortunately surgery will probably not help and treatment will be terminated. In some cases the trigger point that was injected improves however new additional trigger points were unmasked and they are now causing headaches. In this case, the new trigger points will be injected and a new evaluation performed in four weeks.
The four most common trigger point locations are:
- Frontal headaches above the eyebrows. These headaches onset in the glabellar area from sub orbital and supratrochlear nerve irritation.
- Temporal headaches in one or both temples. Pain is most commonly felt in the morning, usually as a result of teeth clenching at night.
- Occipital headaches in the lower back of the head or neck. These headaches occur when the occipital nerve is negatively affected as a result of the semispinalis capitis muscle.
- Rhinogenic headaches behind the eyes. This is triggered by septal pressure on nerves, allergies, or weather change.
Migraine Surgery Process
Migraine surgery can be performed under either local or general anesthesia depending on the severity of the case. Surgery can take anywhere from 2 to 6 hours depending on the number of areas to be addressed. Most patients go home the same day with a family member or friend. Dr. Hamawy will use one or more of the following techniques depending on the location of the trigger points.
Frontal Migraine Surgery
This is performed for patients who have migraines that are triggered above the eyes and can be through small incisions hidden in the upper eyelids or hidden in the hairline of the scalp. The technique is very similar to the approach plastic surgeons use for cosmetic of surgery of the eyelids or eyebrows. To take the pressure off the nerves, the muscles that normally make you frown are removed. Both sides are treated even if the symptoms occur on only one side to avoid having facial asymmetry.
Temporal Migraine Surgery
For migraines that usually start from the side of the head or temples, a small nerve, the zygomaticotemporal nerve, is released through the temporalis muscle.
This also is performed through very small incisions hidden in the scalp.
Occipital Migraine Surgery
This approach is used for headaches that normally start at the back of the head or neck. They are usually caused by the greater occipital nerve being pinched by the Semispinalis Capitis muscle and by the greater occipital artery and vein. Surgery involves releasing the nerve from the structures applying pressure including the muscle and vessels thru a small incision on the back of the head.
Nasal Migraine Surgery
Nasal migraine headaches usually start behind the eyes and around the sinuses and nose. They are triggered by the nerves being pinched by a deviated nasal septum inside the nose. These migraine headaches are often weather related and may be worse when the nose is congested. Unlike in the other trigger points, BOTOX® cannot be used to confirm this. Therefore, in patients with a noticeable deviated septum, and in those not responding to BOTOX®, a CT scan will be needed to determine if a deviated septum is the reason for the migraine.
Quick Migraine Surgery Facts
- Length: 2-4 hours depending on the number of trigger areas
- Anesthesia: General
- In/Outpatient: Outpatient or one night in hospital
- Recovery: Return to work: 1 week – Light exercise: 2 weeks – Return to full activity: 4 weeks
If you do not qualify for a migraine surgical procedure, or do not wish to undergo a surgical procedure, Dr. Hamawy may recommend injections to alleviate the pain.
Botox is used to identify trigger points before surgery, but in some cases the injections are enough to alleviate migraine pain and surgery is not necessary. Botox temporarily relaxes the muscle it is injected into, thus relieving pressure on the nerve. The injections may be administered near the hairline, above or between the brows, above the ears, and/or in the back of the head. The injection is shallow, barely passing the skin, so numbing solution is not needed; it is available if desired. The treatment takes about 15 minutes to complete and requires no time off from work. Results can be realized as early as about 4 days after treatment, but routine injections are needed every 3 months to maintain lasting relief.
Pain blocking is a similar surgical alternative. This is done with a steroid and local anesthetic solution, but it is injected into the irritated nerve, not the compressing muscle. The injection calms the nerve, but will also require continued treatment. This treatment is done under anesthesia.
Some discomfort is normal following surgery, however, there is usually not a lot of pain. When you are discharged, you will be given prescriptions to keep you more comfortable. You may shower the following day. Most patients return to work after one or two weeks, however, plan on having limited physical activity and restrictions against exercise for at least four weeks.
Your follow-up visits will usually start five to seven days following your surgery for a checkup. During your postoperative visits, Dr. Hamawy will review activity limitations, incision care, and concerns you may have. Following this visit you will return in approximately 3 weeks, 3 months, 6 months and one year.
It is important to remember that you may still have some headaches after surgery but they should be much less frequent and nowhere near as intense as the migraines you had before. Be assured that your relationship with Dr. Hamawy does not end after your surgery. If you have any concerns during your recovery, or have more questions at a later time, you can always contact Dr. Hamawy.
Multiple studies have confirmed that migraine surgery is very successful in well selected patients. Success rate of migraine surgery approaches 90%. Most patients witness at least a 50% reduction in migraine frequency, intensity and duration. Some patients, about 35%, are fortunate enough to have complete elimination of migraines from their life. Results vary from person to person, but are generally enjoyed within the first month after surgery.
After your initial consultation, you will be quoted a price that will include Dr. Hamawy’s fee as well as the operating room and any anesthesia fees. Please check with your insurance to see if they cover the BOTOX® injections for migraine headaches as well as their coverage for the migraine surgery. Financing options are available if needed, if not covered by your insurance plan.