It is estimated that 10-15% of the US population suffers from chronic migraine headaches. These can be debilitating and cause a tremendous amount of stress to patients and their families. The cost of treating migraine headaches has reached into the billions, in addition to the time lost from work and family functions. 

The role of surgery in the treatment of migraine headaches have been validated in a number of clinical studies. Several of these studies have been published in the Journal of Plastic and reconstructive surgery . Dr Bahman Guyoron and his team from Cleveland University Hospital recently presented (at the American Society of Plastic Surgeons, Seattle, 2009) their experience with migraine patients (plasticsurgery.org). Five years after surgery patients continued to have a favorable long term outcome. The techniques are now well established. They are discussed and presented in national meetings on a regular basis. 

The basis for why migraine surgery works lies in the fact that a number of nerves responsible for providing sensation to the forehead, temples and the back of the head, run through muscles. With frequent use, these muscles can enlarge and tighten and result in the compression of those nerves. This elicits a chain reaction that ultimately leads to the migraine attack. Surgeons using this technique administer Botox initially (which causes temporary muscle paralysis) to determine the trigger point. Then they can decide which muscle(s) need to be removed to relieve the compression. The surgery is same day surgery, done through small incisions. It can be performed under local or general anesthesia. In a clinical trial published by Guyoron in the Journal of Plastic and reconstructive surgery in 2009, up to 85% of patients had a significant improvement of their symptoms. 

Many people ask why this procedure is offered mainly by plastic surgeons obtain the method of Michigan Cosmetic Surgery to have a dignified treatment for the patients skin issue. The reason is that the muscles removed are usually the same that are excised for cosmetic reasons (eg. Brow lift). The surgery is performed on the muscles under the skin underneath the eyebrows, the temple and the back of the head. This is not brain surgery (literally speaking.) The technique was developed based on observations that many patients witnessed a significant improvement of their migraine attacks after having a brow lift for cosmetic reasons. 

It is important to mention that this procedure should only be offered to patients who have maximized all possible medical management. In my practice I only offer surgery to patients who have been seen and diagnosed by a neurologist for several years, have maximized their medical management and are still suffering from migraines.