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Surgery for Migraines

Migraine surgery in Houston and the Woodlands

Migraine surgery, also referred to as cranial nerve decompression surgery, or chronic headache surgery, is a breakthrough for patients suffering from regular migraine headaches.  Thanks to Dr. Linville’s extensive training and double board certification, he is able to be one of the few plastic surgeons in the world offering this unique and exciting cure for migraine headaches.

Chronic headaches and migraines affect a staggering percentage of the population, and it is likely that if you know four people, one of them suffers from these headaches at least once every other day.  This leads to a reduced ability to enjoy life, to be productive, and lots of missed days from work.

All too often, migraines are blamed on the patient, instead of it being recognized that it is truly a debilitating, potentially devastating problem that can affect people’s daily lives in ways most others just simply cannot understand.

History of Nerve Decompression Surgery

The story of how this surgical development arose is actually quite fascinating, and the phenomena of migraines and how they are caused are only slightly understood, which means there is a lot of room and opportunity for groundbreaking developments.  It just so happens that a plastic surgeon, Dr. Guyuron, who practices in Ohio, noted that a few of his patients stopped having migraines after they underwent an endoscopic browlift.  In this procedure, the corrugator muscles that wrap around the supraorbital and supratrochlear nerves, are partially resected to reduce wrinkling.  After doing some intensive investigating, Dr. Guyuron discovered that the nerves were being compressed by the muscles, which was leading to the migraines.  Once the compression was relieved, the migraines stopped.  Further studies showed that there are even more nerves, both on the front and the back of the head, and many more compression sites for each nerve, that can cause people to suffer from this life-altering problem.

Since his discovery, many studies have been performed and are well documented, that this surgery is able to at least partially reduce, and potentially completely cure, chronic headaches or migraines.  For people who suffer from this on a daily basis, the thought of no longer having a migraine is simply overwhelming.  Fortunately, that day is here.

How does it work?

Once you are diagnosed with a migraine, it is important to determine where the pain or headaches seem to start.  Often, this will either be in the front by the eyes, on the sides near the temples, or on the back of the head.  Sometimes, patients will be able to specifically point to the area where their headaches always start, and other times it is more vague.  Usually through careful history taking and sometimes keeping track in a diary, the various trigger sites can be identified.

The more focused or pinpointed the locations are, the more likely for a quick, successful end to the migraines via surgery, because it becomes easier to target these specific nerves via surgery.

Once the decision to operate is made, the surgery is actually safe and thanks to recent detailed anatomic studies, relatively straightforward, although highly technical.  If your headaches seem to start on the back of your head and then radiate, Dr. Linville will target the back first.  If the headaches seem to be originating more from the front or sides, then those areas are targeted first.  The incisions to locate the nerves are actually fairly small, and almost all are located within the scalp, so no one except you will even know they are there.  Occasionally, the causative nerves above the eyes will need to be released, which can be done through a brow lift incision, or through a common upper blepharoplasty incision, all of which are well concealed, and can even be combined with the cosmetic component for the right patients.

What about Botox?

As mentioned, muscles can act as a constriction point for several of the involved nerves.  This is why Botulinum toxin can be somewhat effective, especially early on.  What studies have shown, however, is that the muscles are only one of potentially 7 to 8 sites where the nerves can be constricted!  There are many other things that can cross over or intertwine with these nerves which can irritate them and thus trigger headaches.  These things are:  fascial bands, ligaments, bony foramina, arteries, septae, and many more.  It’s no wonder that Botulinum toxin is only mildly effective and eventually wears off, and this too, has been shown in the medical literature.

Pathophysiology of Migraines

The nerves in question are nearly all branches of the trigeminal nerve, which is predominantly a large network of sensory nerves that branch out across the back of the scalp and face, including by the eyes.  The reason this nerve decompression surgery works is that the nerves can get constricted, as mentioned above, by many different methods.  The process of why constriction triggers migraines is similar to the process involved in Carpal Tunnel Syndrome.  Constriction and pressure lead to nerve irritation and pain.  However, because the trigeminal nerve branches are so unique and interconnected, if one nerve branch becomes unhappy, it actually sends a signal backwards and then out to the rest of the nerves, which causes the whole process to signal irritation and inflammation cascades.  This is likely some sort of protective evolutionary mechanism, built into the basic physiology of nerve function, but it nevertheless leads to the debilitating symptoms that migraine-sufferers know all too well.  Overall, this theory is known as the peripheral trigger hypothesis, and although it is still not completely understood, it makes intuitive sense from a scientific perspective.

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What’s Next?

The first step if you are having regular headaches that seem to fit the diagnosis of migraines, is to get a formal diagnosis of a migraine by an experienced neurologist.  They might be able to help you discover triggers and take medication that prevents the need for surgery.

However, oftentimes there is no need to wait, and the medications themselves can have side effects also.  A good neurologist will be able to ascertain if you are a good candidate for nerve decompression, and should refer you without hesitation for surgical evaluation.  If you find that this is not happening, you can simply seek consultation on your own.  Chances are, that your neurologist is not up to date on the data behind migraine nerve decompression surgery, or that he or she does not believe in it from a philosophical standpoint.  The neurology societies have been hesitant to adopt an aggressive mindset, and not without logical reasoning.  Neurologists are trained to think medically, and to try to find medical alternatives to surgery when possible.  Surgeons are trained to think surgically, and from a surgical perspective, if we can offer a patient a surgery that offers a lifetime cure and eliminates the need to take costly medications that can have untoward side effects, we will of course do so.  As more studies are done and more quality gleaned from them, I have no doubt we will eventually find a cure for migraines and chronic headaches.  It is imperative to work together in collaboration, as both perspectives can be enlightening.


Will Insurance Cover My Migraine Surgery?

This is truly up to the patient’s insurance company and his or her policy.  Our office will do our upmost to submit all required documentation and supporting literature to our patient’s insurance companies in order to try and get approval for this medically necessary procedure.  Often, insurance companies will realize that they will spend a lot less money in the long run if they can help their client get a resolution to their daily or nearly daily debilitating migraine symptoms.  So, in some cases, we are able to obtain insurance approval.  Hopefully over the next few years, the plastic surgery societies will be able to get Congress to enact a law mandating that this life-changing procedure be covered.  But until then, we can of course not guarantee anything.  More often, because it can take several weeks or months, patients will simply elect to pay out-of-pocket for their surgery, which of course is accepted, but unfortunate.


Recovery time is typically just a couple of weeks, as the incisions heal and sutures or staples are removed from the scalp.  There is usually not a lot of pain, and occasionally patients will say they woke up and their migraines were gone!  Of course, that doesn’t always, happen, and sometimes the surgery itself, just like Botox injections, can trigger a migraine, as the nerves are initially irritated from the dissection.  Typically though, once this goes away, the headaches are much better, or potentially gone forever.

Book an appointment with Dr. Linville online today!