Posted On: August 6, 2014 by Patrick A. Malone

Surgery Remains a Questionable Treatment for Migraines

The extreme pain and frequency of migraine headaches lead some sufferers to seek any treatment short of beheading, but recent research questions the effectiveness of a surgical solution.

Migraine surgery is often called “nerve decompression” or “trigger point release” surgery. It was developed, according to a report on AboutLawsuits.com, after some plastic surgery patients reported relief from migraines following facial rejuvenation surgery (“face lift”).

Scientists at the Brigham and Women’s Hospital in Boston reviewed two migraine studies of trigger point surgery, and found that neither made a compelling case for the treatment. Their report hasn’t been published, but was presented at the annual conference of the American Headache Society in June.

According to the National Institutes of Health, more than 1 in 10 people around the world suffer from migraines. The pain often is an intense throbbing on one side of the head, and patients generally are sensitive to light and sound, often experiencing nausea and vomiting as well.

The disorder is a dysfunction within the brain, and according to AboutLawsuits, researchers are skeptical that such a highly complex brain problem can be alleviated by the removal of facial muscle.

Surgery is never the first plan of action for treating migraines; generally, it has been reserved for patients whose symptoms don’t respond to medications or lifestyle interventions. The source of the problem, according to an information backgrounder by Massachusetts General Hospital, is the trigeminal nerve, a large nerve branch in the face and neck that can trigger migraines. Once the nerve is irritated or stimulated, it sends a chain of messages that culminate in a migraine attack.

The surgery removes the irritated portion of the nerve or the muscle around it. Sometimes it involves other nerves or muscles in the face or neck. Mass General says that surgical treatment “can provide a long-term solution for patients who are severely or chronically affected by migraines. Many studies have reported over 90 percent effectiveness, with most patients enjoying significant to complete relief of their migraines after migraine surgery.”

The website does not specify those studies.

Dr. Paul Mathew, leader of the review study, said his team found flaws in the methods of the two original studies, and that the evidence doesn’t support the claims that migraine surgery is the best treatment for migraine headaches.

The first study reviewed involved only 75 patients, half of whom were given the migraine surgery and the others were offered a fake surgical procedure. The success rate for the first group was quite high — more than 8 in 10 patients reported a 50% decrease in migraines. But nearly 6 in 10 patients who got the fake procedure also reported a decrease in migraines.

Researchers say the studies are flawed and the surgery cannot be judged to be truly effective in relieving migraines. They say there were problems with how patients were recruited for the surgery, questions about them being administered migraine medication before the surgery and if any medication was taken following surgery.

Like all surgery, this one has risks, including sagging eyelids, neck weakness, wound healing problems and nerve injury. Permanent side effects include persistent itching and numbness in areas affected by the surgery.

And although it’s generally a same-day procedure involving minimally invasive technique, the surgery is expensive, at nearly $15,000. Most insurance companies don’t cover it. Usually, it’s performed by a plastic surgeon, not a migraine specialist.

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