Ft Worth Nerve Decompression Surgery
It is thought that sensory nerve irritation near muscle is involved in trigger sites for migraines. Some of these trigger sites can be targeted by surgical intervention. Trials with Botox® in these areas can help determine if you are a candidate for surgery.
Many people who suffer from migraines have only one or two migraine attacks each year, but some people have several migraines each month. Millions of people in the world suffer from migraines, most commonly women 25-55 years old. Migraine sufferers often have difficulty leading a normal life, with unplanned time away from work and other routine activities. Migraine attacks can last for hours to days, leaving you unable to function normally.
If you routinely have more than two migraines each month, it may be better to try to prevent the migraines from occurring (prophylactic therapy) rather than trying to stop them after they start (abortive therapy). There are several ways to prevent migraines.
Is Migraine Surgery Right for Me?
If you answer YES to the following questions, call to make an appointment with Dr. Kirby to discuss if migraine surgery is right for you:
- Have you been diagnosed with chronic migraine headaches by a neurologist?
- Do you routinely have 2 or more migraine headaches every month?
- Have you tried several different types of medication to treat and/or to prevent migraine headaches?
- Do you feel that your migraine headaches are not well controlled?
Using Botox® for Migraines
The normal contraction and relaxation of muscles in your head and neck can squeeze nearby nerves, causing irritation that leads eventually leads to a migraine. Botox® (onabotulinumtoxin A) is now FDA approved for the treatment of chronic migraine headaches in adults. Botox® is injected into specific muscles of your head and neck. This helps to identify your personal trigger points for migraines. The effect of Botox® takes about 5-7 days to start working and lasts for 3-4 months. The procedure takes about 10 minutes to perform and is accompanied by minimal discomfort. The number and location of injections depends on your migraine patterns. Botox® was first FDA approved in 1989. Plastic surgeons noticed that when they injected Botox® for wrinkles, patients had relief of migraines while the Botox® lasted. Some insurance companies will pay for injection of Botox® for migraines. Check with your insurance company regarding their policy on Botox® before your appointment with Dr. Kirby.
Once Botox® has been used to identify your personal trigger points for migraines, surgery can be performed to permanently release the muscle or nerve in the problem areas. You may have one or more trigger point areas that require surgical release:
- Forehead Migraines typically start behind the eyebrows or between the eyes and may be worse in the late afternoon. One side may be more affected than the other. Treatment of the frontal zone focuses on the glabellar muscle group, including the corrugator supercilii, depressor supercilii, and procerus muscles. Release and removal of the muscles can be performed directly through an incision in the upper eyelid or endoscopically, through small incisions hidden in the hairline.
- Temporal Migraines typically start in one or both temples and may be worse in the morning. There may be temporomandibular joint (TMJ) tenderness and a history of grinding teeth. Temporal migraines are treated by removal of a segment of the zygomaticotemporal branch of the trigeminal nerve. Removal of a portion of this nerve is well tolerated since there is only a slight sensory defect and surrounding nerves help return some sensation to the skin. This area is treated through an upper eyelid or hairline incision.
- Occipital Migraines often arise in the back of the neck and head before spreading. Occipital migraines are often initiated by stress or heavy exercise. This type of migraine is treated through an incision on the back of the neck to release the greater occipital nerve from the surrounding semispinalis capitis muscle.
- Nasal Migraines typically start around the eyes and nose, and may be worse in the morning. Migraines are often weather-related, allergy-related or hormone-related and may be accompanied by nasal drainage. In these patients, a deviated septum and enlarged inferior turbinates irritate local nasal nerves, causing migraine pain. An exam by Dr. Kirby and a CT scan can determine if you have a deviated septum that may be contributing to migraine pain. Nasal migraines can be treated with septoplasty and reduction of the turbinates.
Depending on your specific area(s) of migraine trigger points, surgery may be performed through an upper eyelid (blepharoplasty) approach or through the scalp, using minimally-invasive, endoscopic (camera) access.
Over 90% of patients who undergo migraine surgery have an improvement in the number of migraines, length of migraines, and/or severity of migraines (Guyuron 2005). Approximately 35% of patients have complete relief of their migraines.
Reimbursement assistance for patients who are uninsured or otherwise unable to afford Botox® can be found on the Botox website. Or you can call 1-800-44-BOTOX, option 4. The form you are required to complete can also be downloaded from the Botox® website.
If migraine headaches are affecting your quality of life, please contact our office at 817-292-4200 for an appointment with Dr. Kirby.