Currently, there is no strong evidence to suggest that surgery works reliably as a treatment option for migraine across a large population. Research supports its use for occipital migraine, but this is a different condition.
Occipital migraine is more accurately known as occipital neuralgia. It involves the occipital nerve becoming inflamed and irritated, causing pain. There is
Currently, the Food and Drug Administration (FDA) has not approved NDS as a treatment option for migraine. However, the FDA has approved other procedures — such as Botox — for this condition.
This article looks at surgery for migraine, including some of the available procedures and the evidence behind them. It also looks at some less invasive options for relieving pain.
People can get surgery for migraine, but there is no consensus on whether it is effective across a large population.
Migraine is a complex neurological condition that does not appear to have a single cause. According to a
Some people claim that undergoing surgery to reduce pressure on nerves can relieve migraine pain, but research is not conclusive. Smaller studies, such as a 2020 study in which 70 people underwent NDS, have reported success. The authors report that
However, a larger 2019 meta-analysis found that, out of 627 participants, surgery eliminated migraine headaches in only 38% of people. The authors of the analysis state that more research is necessary to determine if surgery could be a reliable migraine treatment.
A neurologist may suggest surgery to people whose migraine headaches have not responded to any other standard treatments.
It is likely that candidates will already have tried:
- pain management with medications, such as triptans
- making lifestyle changes to avoid triggers
- nonsurgical procedures
It also helps surgeons if the person has clearly identifiable “trigger sites” around the head. These are specific places where migraine pain begins at the start of each episode.
The four areas that surgeons work with are the:
- frontal, or forehead, region
- temporal region
- nasal region
- occipital region
The person will also need to be healthy enough to undergo surgery and have a low risk of complications.
There are several different types of procedures that surgeons can use to try to eliminate migraine permanently. The sections below look at these in more detail.
In order to perform NDS, a surgeon inserts specialized surgical instruments through a small incision in the skin. They then use the tools to cut away tissues that are compressing and restricting the nerves. This releases pressure on the nerves.
Whereas NDS involves detaching tissues that surround a nerve, neurectomy involves cutting the end of the nerve. This prevents it from sending pain signals.
To perform this procedure, a surgeon pinpoints the exact area where the person’s pain originates. They then use an ultrasound scanner to identify the nerve associated with the pain before making an incision.
Surgery for migraine is usually minimally invasive, which means that it only involves small incisions.
Healing times can vary depending on the type of procedure a person undergoes.
Immediately after surgery, there may be:
- shooting pains
Less often, people may experience:
Usually, these side effects improve within a few months.
People can aid recovery by following the surgeon’s aftercare instructions. This will involve:
- keeping the area clean
- monitoring for symptoms of infection
- applying any topical medications that the surgeon recommends
- reporting any unusual or adverse effects immediately
Any surgery comes with a risk of infection as the wound heals. However, NDS and neurectomy also have small risks of other complications, including:
- Dry or runny nose: People who have NDS or neurectomy in the nasal region may develop a dry or runny nose after surgery. Sinus inflammation is
also possible. If the person previously had a deviated septum, it may come back.
- Neck stiffness: With surgery in the occipital region, one potential complication is a stiff or numb neck.
- Neuroma: A neuroma is a mass of nerve tissue that can develop after neurectomy. This can be painful, and an infection may develop. However, surgeons can try to prevent this by burying the ends of nerves in muscle tissue.
- Temporal hollowing: People who undergo surgery in the temporal region may experience temporal hollowing. This occurs when the temples become flat or depressed. Although this is not serious, it does affect a person’s appearance. In a previous study, 53% of people who underwent this type of surgery developed hollow temples.
In addition to neurectomy and NDS, there are other procedures that people can try for migraine treatment. These are less invasive and typically reversible. The sections below look at some of these in more detail.
Botox is a type of toxin. Doctors can administer Botox injections into tissues that migraine headaches affect. The Botox enters the nerve endings, where it blocks the release of chemicals involved in transmitting pain signals to the brain.
Botox injections typically last for about 3 months. However, a person may require several treatments before they begin to notice results.
The FDA has approved the use of Botox as a treatment option for chronic migraine in adults. Doctors may also prescribe Botox off-label as a migraine treatment for children and adolescents.
Acupuncture involves inserting metallic needles into specific pressure points beneath the skin. The aim of acupuncture as a migraine treatment is to slow pain transmission.
According to the American Migraine Foundation, up to 59% of people who undergo acupuncture for migraine report that their headache frequency reduces by 50% or more. This effect may last for longer than 6 months.
Vagus nerve stimulation
This FDA-approved procedure involves placing electrodes around the vagus nerve. A person then uses a device to deliver small electrical impulses to the area.
According to the American Headache Society, clinical trials suggest that vagus nerve stimulation can decrease pain and that there are no significant side effects associated with the treatment.
People can get surgery for migraine, but research into how effective these procedures are is ongoing. Some people may find symptom relief from NDS or neurectomy if all other treatments have not worked and if there is a specific origin point for the pain.
Less invasive alternatives to migraine surgery include Botox injections, acupuncture, and vagus nerve stimulation.
A person should talk with a neurologist about the benefits and risks of different migraine treatments before deciding on a particular option.