Surgery for migraines – an update

In my post 2 years ago I wrote about surgery for migraines and the many reasons why Botox injections is a better option than surgery to permanently cut nerves and muscles.  I also wrote that there were no controlled studies to show that surgery actually works.  Now we do have one study.  The study was blinded, which means that some patients had nerves and muscles cut, while others had only a skin incision.  The results were much better in patients who had real surgery.  The plastic surgeons who performed the study tried their best to produce a blinded study, but they admit that blinding is far from perfect since patients who had real surgery can see their muscles shrink or not move.  But even if we accept that blinding was achieved and surgery indeed provides relief of headaches, all of my other arguments stand.  These include surgical risks (bleeding, infection, scarring, and persistent nerve pain) and high cost.  Yes, Botox is expensive too, but migraine usually is not a life-long illness and migraine attacks often stop for long periods of time or permanently with or even without treatment.  I have seen many patients whom I treated with Botox every 3 months and whose headaches stop after a year or two.  Two years of Botox treatments is significantly cheaper than surgery and it does not carry all of the surgical risks.

  1. Dr. Mauskop says: 06/17/20114:38 pm

    My most dramatic and convincing case was that of a 76-year-old woman with 60 years of headaches. Her headaches became daily in her 40’s. She had tried dozens of medications and many procedures without relief and I was doubtful that Botox would help, but it completely eliminated her headaches after the first treatment. This kind of success is unusual, but Botox is always worth trying because it works for about 70% of patients and in experienced hands has very few side effects.

  2. Helena says: 06/16/20117:03 am

    Dear Dr Mauskop,
    I was reading about Dr Guyuron’s surgery results for migraine and thought they look pretty promising. Would be interested to know, though, about patients you saw improve with 1-2 years of botox. My migraines have been persistent and progressive for 19 years (i’m 46 now). Is botox likely to be successful in this case?

    If you need more information: Preventive medication has not helped, in fact I got worse once i started trying preventive meds. I’ve gone from chronic frequency of migraine – daily symptoms, typically >= 15 days/mo on meds for attacks – to episodic migraines with lifestyle, diet and exercise according to Buchholz’s “Heal Your Headache” plan. Now i get migraines around the time of my period and i only take ibuprofen, but lots of it and still am semi- to non-functional for several days of the month, not mention exasperated from years of dealing with this. HYH is a huge improvement i’m greatful for, but i’d still like the rest of my life back. Post menapause might (or might not) be an improvement, but that’s probably 15 yrs away.

    if you get a moment to reply, that’s great. thank you.

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