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 Surgical deactivation
of migraine headache trigger sites can eliminate or significantly
reduce migraine symptoms.
Migraine headache
affects an estimated 12 percent of the American population.
Candidates for
migraine surgery must have a diagnosis of migraine headache confirmed
by a neurologist.
There are four
trigger sites for migraine headache that can be treated by surgical
deactivation. Patients who are candidates for migraine surgery
are those who experience frontal, temporal, occipital, or nasal
migraine headaches. It is important to undergo testing with
Botox®
treatments to determine exactly which trigger sites would be
candidates for surgical deactivation.
It has been shown
that 93 percent of patients undergoing such surgery will benefit by
having greater than 50 percent reduction in the Migraine Headache
Index and total elimination of migraine headache was found in 35
percent of those undergoing surgery. Surgery resulted in less
time lost from work and decreased cost of migraine care.
It is felt that
migraine headache may be started by the mechanical stimulation of
potentially sensitized peripheral sensory nerves, resulting in
dilatation of vessels caused by the release of peptides. The
surgery is designed to eliminate this stimulation that causes the
migraine process.
Dr. Tuckman is
a pioneer in bringing migraine surgery to the New York and New Jersey
area.
Contact us for more information on Migraine Surgery
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How are patients selected? |
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Patients must be seen by a neurologist and must have a diagnosis of migraine disease. The initial consultation with Dr. Tuckman is to determine whether the patient is a candidate for testing for surgical treatment. There are four currently known trigger sites for migraine: brow, temple, back of neck, and nasal passages. The brow, temple, and back of neck sites can be evaluated with injections of Botox® . The nasal passages can be tested with nasal sprays, as well as with physical and x-ray findings.
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How long is the selection process? |
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Following the evaluation visit, variables such as frequency, severity, location and duration of migraine headaches are tracked each day for one month. With this information, Dr. Tuckman will begin a series of injections of Botox® in specific trigger sites. One site is injected at a time, with one month between injections. The patient tracks the results during the month following each injection until all trigger zones are identified. This information gives Dr. Tuckman the data he needs to predict the likely outcome of surgery. Those patients who observe a significant reduction in frequency and severity of migraine headaches with the use of Botox® are considered excellent candidates for surgery. The surgery does on a permanent basis what the Botox® does on a temporary basis. Exceptions to this schedule may be made for out-of-state patients, or for those who have already undergone trigger point testing by another physician.
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How does Botox® affect migraine headaches? |
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Botox® results in the temporary weakening of the muscles that impinge on the nerves which have been pinpointed as trigger areas for migraine headaches.
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How do I know if I am a candidate for surgical treatment? |
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Botox® has proven to be extremely reliable in predicting those patients who will benefit from surgery. Of the 60-80% of patients who respond favorably to the injection of Botox® , 90% of those will benefit from migraine surgery.
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What is recovery like?
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Patients are out of work for one to two weeks until swelling and bruising is resolved. Discomfort is treated with appropriate pain medication.
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Are there scars? |
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Yes, however, all scars are hidden in the hair or at the hairline. Nasal airway incisions are inside the nose.
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Will my insurance cover Botox® injections or the surgical procedure?
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At this time, some insurance companies cover the injection of Botox® , however most insurance companies do not cover the surgery.
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Can Botox® be used as a treatment? |
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Yes and no. For those patients who have frontal headaches only, injection treatment may last for 6-12 weeks. Most patients also have temple or neck issues. Long term injections in the temple region will result in hollowing of the temples, otherwise known as “hourglass deformity”, giving a starved appearance. Long term injections in the neck are not likely to cause a problem, but may last just 6 weeks. Nasal airway triggers can be helped with decongestants, but otherwise must be treated surgically.
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How many sites usually need surgery? |
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Usually, two or three sites need addressing. Less commonly, single site or four site patients are encountered.
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Can anyone inject Botox® ? |
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Yes and no. The most effective, longest-lasting Botox® injections are those injected into the anatomically correct location. Injections into areas which have failed to respond to previous Botox® injections may be successful if the injecting surgeon works within and is familiar with the anatomy in three dimensions.
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What are the benefits of surgery versus medications?
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The use of medications for migraine headache relief has helped migraine sufferers to a certain degree. The patient generally has to endure symptoms until the medications take effect. Also, patients generally endure an array of side effects associated with their medications. The discovery that surgery can greatly decrease or eliminate migraine headaches has given hope to those who suffer from this debilitating disorder. Surgical treatment can be viewed as a shift from long term dependence on multiple drugs to a complete disruption of the migraine circuitry, ending the migraine cycle and all the lifestyle disruption that it causes.
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