Migraine Surgery

It is often necessary to change the lifestyle in order to reduce migraine attacks.  It is recommended to avoid food such as coffee, cigarettes, alcohol, fermented foods, obsolete cheese, chocolate, which are foods that trigger the migraine. Painkillers can be used to relieve pain at the time of attacks. Although there are many treatment options to treat the migraine in medicine or alternative medicine, patients can be evaluated for Migraine Surgery in case of advanced and resistant migraine.

When an effective result cannot be achieved by medication, botulinum toxin treatment or migraine surgery must be considered. Botulinum toxin procedure can be offered as a treatment option for patients who have less than 2 migraine attacks in a month. Patients with more severe migraine can be evaluated for migraine surgery.

Points causing migraine are loosened and compressed nerves are relaxed. Thus, pain triggering stimulants sent to the brain by the nerve are eliminated. If the migraine pain starts from eyebrows, nerves are reached by placing a camera under the skin on the front line of scalp with short incisions. If pain starts at temporal area, sensory nerves are intervened with an endoscope. If pain starts on nape, nerves on the right and left are reached with an incision inside the scalp from midline and loosened. If the pain starts on the back of eyes, it is checked if there is a cartilage deviation on the nose and the relation of intra-nasal soft tissues with cartilages is examined. Triggering points that are thought to be the origin of the migraine are determined before the treatment and the migraine surgery is decided with the patient.

Migraine is a vicious circle of processes which originates in the brain, sometimes can be repressed by drugs but mostly cannot be treated and progresses with attacks and restricts one’s life. Many treatment methods have been used until today but no method has been found which generally achieves an effective result. It is because the main reasons for migraine cannot be determined and studies rather focus on relieving the symptoms. This situation turned into a challenging process during which patients and countries spend money continuously and only a temporary recovery is provided or not provided consequently. Other interventional procedures have an impact on the disease by changing the direction of the pain, but the solution which is targeted to the reason was not known until the 2000s.

Bahman Guyuron, a famous American Plastic Surgeon, stated that his patients relieved from their migraine attacks besides achieving aesthetic results of forehead lifting and eyebrow lifting in the 2000s. The steps taken to effectively resolve migraine which affects about one-sixth of the world’s population, have become a treatment with an international validity in recent years by starting from this period. The fact that migraine has a complex nature and the dogma and definitions that have been built over many decades have gone through central theory has led to the perception of disease as a matter of concern by neurologists. Today, many scientific studies have been made about Migraine Surgery and results of migraine surgeries, which are being carried out all over the world, are being shared day by day in the form of articles. Although the answer of “why plastic surgery” seems to be coincident, in fact, this can be understood more clearly when the interests of Plastic Surgery are investigated. Plastic Surgery has an important place in order to rescuing the damaged, compressed or functionally impaired peripheral (superficial) nerves from the trapped areas with micro surgical methods which are not familiar to most of us and we encounter in case of necessity.

The basic approach can be described as the impingement of the superficial nerves that transmit the sense of the pain to the brain in the micro environment or to be affected by environmental stimulants. The defined Trigger Point Theory focuses on the assumption that migraine attack has a starting point, in which the mechanical impulse transforms into a chemical effect that triggers the nerves, and this situation initiates the migraine-triggering process in the brain.

Migraine patients who are precisely diagnosed with migraine by a Neurologist, who have two to three attacks in a month even under the drug treatment, who cannot use or do not want to use medicines due to the side effects are good candidates for migraine surgery.

It should be noted that especially aspirin, one of the blood thinners must be stopped three weeks prior to the surgery and not be used for one week after the surgery. Besides, the use of vitamin E and herbal products can also lead to bleeding.

It lasts about 40 minutes for each triggering point.

Drain which extends outwardly from the scalp is placed after surgery to prevent blood and fluid collection. Drain is taken out after one day in general. Patient is asked to stay under observation for one day at the hospital. Recovery process changes from person to person but oedema and swellings begin to regress on the 3^rd day and disappear noticeably in 7-10 days. Heavy exercises can be done after the 6^th week. Suture removal is not needed since self-melting sutures are used. Regression of migraine attacks can be seen immediately after the operation in some patients while it might be regressing over time within months in some cases.

Migraine surgery is not a brain surgery. The risk is minimal since it is performed under the skin. The risks associated with the surgery include infection, bleeding, wound healing disorders that can be seen in all surgeries, and generally sensory-related effects such as itching on the scalp, numbness, tenderness may be seen. Risks vary according to the region where the surgery is performed.

Yes, they are similar surgeries, but different in detail. Both are performed under the skin. In addition, eyebrow lift can also be applied preferably to the patients who have undergone the migraine surgery.

Migraine affects 10-15% of the world population. It is more common in women. It is mostly hereditary.

The diagnostic criteria of the International Headache Society are:

• Pain which lasts 4-7 hours
• Accompanying two or more of the following conditions

being lateral and pulsatile

Prodromal Period

Aura Period

Pain Period

Resolution Period

Recovery Period

1. Forehead migraine (frontal migraine)
2. Temporal migraine (temporal migrane)
3. Nape migraine (occipital migraine)
4. Nasal migraine (paranasal migraine)

Genetic and environmental factors are important in migraine aetiology. 2 out of 3 migraine cases have genetic transitions. While it is more prevalent in men before puberty, it is more common in women afterwards.

Tension type headache: It is the most common type of headache. It terminates in 4-6 hours, causing a headache on nape and both sides of head.

Cluster headache: It is more common in men, which is unilateral and lasts from 15 minutes to 3 hours.

Sinusitis: It is a pain around forehead and eyes, which is usually associated with postnasal discharge and increases by leaning forward.

Temporal arthritis: It is an inflammatory disease that mainly affects the external carotid artery. It causes a significant pain in the temporal region.

Acute glaucoma: It is a disease known as eye tension and described with the pain which occurs around the eye.

Meningitis: It is a disease that causes a diffuse headache associated with inflectional meanings.

Subarachnoid haemorrhage: It causes an unbearable headache, which is caused by bleeding in the brain sheath.

The primary theory focuses on the transmission of the uncontrollable pain to the brain through peripheral nerves. The real problem is linked to the constriction and interactions in superficial subcutaneous nerves. When the mechanical problem is resolved and the interaction of nerve tissue with peripheral tissues is taken under control, the main stimulant is removed. Endoscopic migraine surgery, which has high success rates, can significantly relieve the migraine problem which is thought to have no solution although it is accidentally found and can allow the migraine to completely disappear in some of the patients who have become drug addicts and spent their years by competing against migraine.

It varies according to the application area, anaesthesia type and the hospital where the procedure is performed.