A migraine headache can cause severe throbbing and pulsing pain localized to one area of the forehead or scalp. This is not a severe form of a “tension headache”. It is a much different process and can be accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Some migraines are preceded by warnings such as halos, flashes of light, blind spots, or tingling. Still others come without warning.
Migraine headaches are diagnosed with the following criteria from the International Classification of Headache Disorders:
1. At least five attacks with the features of 2-4
2. Headache attacks lasting 4-72 hours. (untreated or unsuccessfully treated)
3. Headache has at least two of the following four characteristics.
a. Unilateral location
b. Pulsing quality
c. Moderate or severe intensity
d. Aggravation by or causing avoidance of physical activity
4. During headache at least one of the following:
a. Nausea and/or vomiting
b. Photophobia (sensitivity to light) and phonophobia (sensitivity to sound)
5. Not better accounted for by another diagnosis.
Migraines affect 12 percent of the American population. 28 million Americans suffer from migraines each year and lose a collective 112 million workdays and 14 Billion dollars in productivity.
As a fellow migraine sufferer, Dr. Mussman can attest that migraines are a very painful and very abrupt interruption to life. School days are missed. Sports games are missed. Life is missed. Migraines cannot be reasoned with. Whatever is planned for the day, no matter how important, is replaced with isolation, pain, nausea, and vomiting in a dark room. In the last 30 years, huge advances have been made in the field of migraine treatment.
For a long time, a diagnosis of migraine headaches ended with a conversation about behavior modification and avoiding foods like chocolate and caffeine. Now this is the start of the conversation. If behavior modifications and relaxation exercises do not work, the medication family called triptans has revolutionized migraine treatment. Triptans result in migraine reduction for the vast majority of people. Triptans work internally (in the brain) where most migraines are theorized to originate.
Some sufferers of migraine headaches were not helped with behavior modification, pills, or injections. Until recently, they had to suffer without any other option. Through listening carefully to patients, plastic surgeons were able to establish a pattern of patients reporting improvement in their migraine headaches after certain cosmetic surgeries such as brow lifts and rhinoplasties (nose jobs). By surgically relieving the nerve compression at these trigger sites, migraines were reduced in 92% of patients by 50% or more and completely eliminated in 31% of patients.
Dr. Mussman is thrilled to bring migraine surgery to the Phoenix / Scottsdale area. If you are suffering from migraine headaches and have received little relief from pills and injections, migraine surgery may be an option to restore control to your life. During your consultation, Dr. Mussman will evaluate your headaches and discuss the process in greater detail to decide if migraine surgery may be right for you.
What to Expect
If you would like to be considered for migraine surgery, Dr. Mussman will:
- Arrange for you to be seen by a neurologist and diagnosed with migraine disease (if not done already)
- Review your history and symptoms of migraine headaches including evaluation of side effects or unsuccessful results from other treatment options
- Obtain a referral from your neurologist for surgical treatment consideration
During your consultation, Dr. Mussman will review your migraine history and treatment goals. Treatment options, including risks and benefits, will be discussed in detail. Creating a migraine diary may also be necessary. We also ask that you bring a list of medications, vitamins and herbal supplements that you take, along with information on dosages.
Migraine surgery typically takes an hour or two. The simpler forms of this procedure may take place in an office setting, while migraines sparked in the septum or occipital nerve are addressed in the operating room. All patients can go home the same day.
Most patients return to work in about a week. Up to 90% of patients may experience relief of over 50% of migraine symptoms within the first month of surgery.
Additional Information-Trigger Points
Trigger Site 1: The Frontal Zone
The frontal zone is the most common site for external trigger of migraine headaches. It can be accessed through a crease in the upper eyelid or endoscopically through tiny incisions behind the hairline. This allows Dr. Mussman to decompress the sensory nerves traveling under or through the muscles that cause the frown lines between your eyebrows. The scientific names of these muscles are the corrugator supercilii, corrugator depressor, and procerus muscles. After the surgery, numbness and tingling can be experienced. These are usually temporary side effects until the swelling resolves.
Trigger Site 2: Temporal Zone
A very small sensory nerve that supplies sensation to skin of the temple can be a trigger of migraine headaches. This can be aggravated by stress and teeth grinding. This nerve becomes pinched in the temporalis muscle. Dr. Mussman simply removes a small segment of this nerve. The numbness is permanent but usually goes unnoticed by most patients.
Trigger Site 3: Occipital Zone
This area can be exacerbated by stress also. Tightening of the semispinalis capitus muscle around the occipital nerve in the posterior neck can cause migraine headaches. By releasing this tiny muscle and redirecting the nerve into the nearby soft fat, compression can be relieved and migraine trigger from this site can be eliminated.
Trigger Site 4: Nasal Zone
Dr. Mussman may order a CT scan to evaluate this trigger site completely. Some patients can experience pain and migraine trigger from deviated septum combined with overgrowth of an area of the nose called the turbinates. When these two areas become inflamed with allergies or stress, contact can cause compression. Compression can cause pain that leads to development of a migraine headache.
These trigger sites account for an estimated 75-90% of all migraine triggers in the head and neck. Over a dozen minor sites have also been described and can be explored if these sites do not relieve the migraines.
If you are interested in migraine surgery, Dr. Mussman encourages you to schedule a consultation to begin the journey to take back control of your life from migraine headaches.