Millions of Americans suffer the debilitating effects of migraine headaches. Until recently the treatment consisted of medication that at best relieved the symptoms but did not cure the problem. Now, however, we have an understanding of what causes some migraine headaches. It’s caused by pressure on a sensory nerve – a nerve that carries the sensation of pain or pressure – as it travels to the brain through an opening in the skull. By releasing this pressure that can be caused by constriction due to muscles, blood vessels, fibrous bands, and tight bony openings, most migraine headache sufferers can be greatly helped and in some cases completely cured. Botox does this temporarily, but in selected patients, surgical release of the pressure reduces the frequency/severity of migraine headaches or eliminates headaches permanently in over 90% of these selected patients.
This nerve compression involves specific nerves located in the back of the head, on the side of the head near the top of the ear, and in the eyebrow region. Patients are evaluated to determine which, if any, of these nerves appears to be triggering the migraine headaches. This evaluation involves Botox injections and other neurologic tests. If it seems as though nerve compression is involved, the affected nerves are surgically released. Those of the back and side of the head are released via incisions in the scalp, whereas those in the eyebrow region can be released via a surgical endoscope or by means of an eyelid incision.
The endoscope is similar to a small telescope with an attached camera that displays the image on a large computer screen. It is inserted through a small incision in the scalp which produces a minimal scar. This technique yields significant migraine improvement in over 90% of selected patients. It is expensive and it’s also difficult to perform in patients with long foreheads, high hairlines, or thinning/no hair.
A recent article from Harvard (PRS Advance Online Article) offers an alternative to the endoscope. Instead of forehead incisions, an upper eyelid incision of the type used for an upper eyelid lift is used to access the nerves.
In this study the patients were first evaluated by a neurologist to make sure that they had true migraine headaches and that there was no other explanation for their headaches. Treatment with appropriate medications was tried first. If this was unsuccessful, surgery was offered. If the nerves triggering the headaches were located in the eyebrow region, the eyelid approach was used instead of the endoscopic technique. The results were as effective – over 90% of patients showed a greater than 50% reduction in their headaches with more than 50% having a complete elimination of their headaches!
This blog does not advocate releasing the eyebrow nerves in every patient with headaches who is having an eyelid lift. Although the incision for a cosmetic eyelid lift is the same as the operation for nerve release, the nerve release operation is a much more involved procedure that has its own set of potential complications. For an appropriate migraine sufferer, however, it may be part of a treatment plan that may reduce or even eliminate their headache problem.
George Sanders, M.D.