What is a migraine?
Migraines are a type of headache that causes throbbing pain at a particular location in the head. The headache can last several hours and can be associated with sound sensitivity, nausea, vomiting, and light insensitivity. A neurologist is a type of doctor who can diagnose a migraine.
Migraines normally occur in a particular order.
- Prodromal phase – The prodromal phase is the start of the migraine. This occurs one to two days before the migraine and can include cramps or certain physical symptoms such as nausea or light sensitivity.
- Aura Phase – The aura occurs right before the migraine. Patients report changes in touch, speech, hearing, and vision.
What causes a migraine?
There are no set mechanisms that have been shown to cause migraines. The migraine is normally a result of factors that occur inside and outside the brain. These factors cause a set of events that ultimately lead to the headache. One of the main factors is related to the interplay between sensory nerves in the face and scalp.
Certain environmental events may actually trigger the migraines. These triggers could include stress, hormonal changes, and environmental factors.
What do I need to know?
Not all migraines are the same. Migraine surgery is a procedure designed to treat migraines related to one of four migraine muscular or nervous trigger points. The trigger points are located throughout the face, scalp and nose.
Dr. D’Souza will work with you to isolate your trigger point. This point is a sensitive point on your face or scalp that when pressed will cause you to feel a localized or ‘referred’ pain in another location of the body. The trigger points in your scalp are confirmed by using a Botox injection to the area. The trigger point in the nose is noted by the use of a spray.
Once we know which trigger point we are targeting, we will plan a surgery to effectively release the entrapped nerve causing your headaches.
What makes you a candidate for surgery?
You will need a specific diagnosis of migraine from a neurologist within the previous 5 years. Furthermore, a good response to Botox injections will be required to confirm that surgery is right for you. If you have been treated effectively with Botox or nasal sprays at an outside doctor’s office we will not need to redo this test at our facility. Before surgery, you will be asked for specific blood work and a general medical examination from an outside doctor. Medical clearance may also be done based on your age or health.
Some cosmetic procedures can be performed at the same time of the migraine surgery. These include brow lifts, rhinoplasties, or eyelid surgery. Dr. D’Souza can discuss these options with you in greater detail in a consultation or pre-operative appointment.
What to expect during the procedure
The migraine surgery is performed in the operating room. The incision is hidden in the hairline, or in the skin creases of your eyelids and face. All incisions will be discussed in detail with you before starting the procedure. During a migraine surgery that involves a nasal trigger point, a small incision will be made in between your nostrils. To safely provide you with the best results an anesthesiologist will administer anesthesia during the procedure. Overall the procedure can take anywhere from 1-4 hours.
What to expect after the procedure
After the migraine surgery, the incision site will likely be covered with medical bandages that provide gentle pressure to help minimize any swelling and bruising. All bandages will be removed the following day and you will be asked to start showering in 24 hours. You will be asked to stay at our adjoining hotel or nearby for the first night. You will be bruised and swollen for approximately 1-2 weeks but most people can resume normal activities around the house in 3-4 days. Pain and discomfort can be controlled with medication during your recovery period. The scars heal amazingly and are nicely hidden behind the ear or with hair.
How long will the results last?
Depending on the trigger sites, patients may notice improvement immediately but it may take months until the full effect is felt. Although uncommon, there is a chance that your migraines will not improve significantly. This is most likely caused by additional trigger sites and may require an additional procedure. It is rare for no improvement after surgery.