The Evolution of Migraine Surgery: Two Decades of Continual Research. My Current Thoughts

Abstract

Summary: A mere serendipitous finding has culminated in a life-changing development for patients and a colossally fulfilling field for many surgeons. The surgical treatment of migraine headaches has been embraced by many plastic surgeons after numerous investigations ensuring that the risks are minimal and the rewards inestimable. Seldom has a plastic surgery procedure been the subject of such scrutiny. Through retrospective, prospective pilot, prospective randomized, prospective randomized with sham surgery, and 5-year follow-up studies, the safety, efficacy, and longevity of the given operation have been confirmed. Although the first decade of this journey was focused on investigating effectiveness and risk profile, the second decade was largely devoted to improving results, reducing invasiveness, and shortening recovery. Multiple publications in peer-reviewed journals over the past 20 years, several independent studies from reputable surgeons at recognized centers, and over 40 studies from the author’s center have established the surgical treatment of headaches as a standard practice.

Computed Tomography Evaluation of Frontal Sinus Volume in Migraine Patients

“…Given the known Schwann cell deletion in migraine patients, 32 decompression surgery is a primary pathophysiological goal due to the result of fibrous band compression at the notch and bone on neurovascular structures. 2 Surgical options for the supraorbital region include foraminotomy, notch release (for fibrous band SO, ST notch), and fasciotomy. 4 Our study suggests that the incidence of a single notch was high in both groups, while a single foramen was more frequently observed in the migraine group.…”

“…D ecompression of peripheral nerve trigger points is used as an alternative form of treatment to relieve migraine pain in those who do not respond to or cannot tolerate conventional treatments. [1][2][3][4][5][6] The presence of foramen and notches on the frontal bone related to the neurovascular structures of the supraorbital region results in more severe complications in migraine patients. 4,5 Therefore, surgical decompression of exiting points of supraorbital neurovascular structures is gradually gaining value for migraine patients.…”

Comprehensive Criteria for Differential Diagnosis and a Surgical Management Algorithm for Occipital Neuralgia and Migraine Headaches

“… 6 , 7 , 8 , 9 , 10 During the ensuing years, he developed different surgical techniques to deactivate the seven identified MH trigger sites: frontal (site I), temporal (site II), intranasal (site III), occipital (site IV), auriculotemporal (site V), lesser occipital (site VI), and isolated terminal branches of any of these nerves, including those responsible for the nummular headaches (VII). 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 The occipital trigger site corresponds to the site of irritation in the distribution of the greater, lesser, and third occipital nerves (GON, LON, and TON). 22 , 23 , 27 , 29 …”

The Scratch Collapse Test for Diagnosis and Treatment of Trigger Sites for Migraine Surgery

“…Surgery through targeted deactivation of peripheral nerves at trigger sites has been one of the most significant recent advances for treatment of migraine headaches. 1,2 Six main trigger sites have been identified, [3][4][5][6] with the average number of trigger sites for each surgical patient reported as being 2.6 in a large series. 7 Diagnosis of trigger sites is key for planning of surgical treatment.…”