The Institute for Advanced Reconstruction is on the cutting-edge of migraine treatments, among the few practices offering specialized procedures in the New Jersey/New York regional area. In fact, our practice has drawn patients from around the country (and even internationally) for various procedures.
There are 28 million migraine sufferers in the United States, one-third of whom find little or no benefit from traditional medical therapies. These individuals often endure severe bouts of debilitating migraine headaches, resulting in frequent work absences and withdrawal from daily activities.
Occipital Neuralgia causes similar problems to migraine headaches, but may respond very differently to certain forms of treatment. Both conditions can be initially treated with medication, yet many of our patients observe better lasting results with Botox® injections. Those who receive successful results from Botox ® treatments may continue with a surgical procedure, “trigger point surgery” or “nerve decompression surgery,” as an intended permanent way of reducing or eliminating their pain.
Matthew R. Kaufman, M.D., F.A.C.S., is one of the senior surgeons at the Institute for Advanced Reconstruction, comprised of a group of surgeons who are highly skilled in nerve transplantation and advanced reconstruction. He is among the most experienced trigger point decompression surgeons in the region and nationally. Dr. Kaufman trained in the very first specialty course offered by a worldwide expert for migraine treatment with Botox® and nerve decompression surgery.
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Both occipital neuralgia and migraine headaches can cause debilitating headaches that interrupt one’s normal life. They often lead to an isolated existence, being unable to visit loud, bright public places for fear of exacerbating symptoms. Many individuals are unable to work or are forced to take multiple sick days that lead to poor work performance and, thus, problems with colleagues and employers.
The International Headache Society (IHS) defines occipital neuralgia as:
A paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves or of the third occipital nerve (nerves running up the back of the neck and head), sometimes accompanied by diminished sensation or dysaesthesia (abnormal sensation) in the affected area. It is commonly associated with tenderness over the nerve concerned.
The corresponding IHS definition of common migraine (now referred to as migraine without aura) is:
Recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia (sensitivity to light and sound).
Both occipital neuralgia and migraine headaches are initially treated with medication in an attempt to reduce symptoms and prevent or alleviate the occurrence of headaches. Although medical therapy can be very effective, for many headache sufferers medication can be less effective over time. If the side effects of the medical therapy outweigh the benefits, the individual may discontinue taking the medications and is forced to deal with the consequences.
Neurologists and other headache specialists sometimes have difficulty diagnosing the headache condition as purely occipital neuralgia or migraine, and there may be some overlap in the classification.
Recently, the FDA approved the use of Botox® as a treatment for chronic migraine sufferers who have headaches 15 or more days per month, each lasting four or more hours. A surgical procedure is offered to those patients who benefit from Botox® therapy, as an intended permanent way of reducing or eliminating migraine headaches, as mentioned earlier.
A surgical procedure known as “Trigger Point Surgery” or “Nerve Decompression Surgery” is offered to those patients who benefit from Botox® therapy, as an intended permanent way of reducing or eliminating migraine headaches. It stands to reason that nerve decompression specialists at The Institute for Advanced Reconstruction would offer this revolutionary treatment, available at only a limited number of locations in the United States.
At the Institute for Advanced Reconstruction, we have been performing trigger point decompression surgery for the last 9 years, and have had tremendous success, most notably in patients with occipital neuralgia. Some of our patients have been essentially “cured” of their condition (they no longer need medical therapy and rarely, if ever, have a headache). We have also had success in treating migraine patients with this procedure, although we need to be much more selective in this group because of the difference in causes.
Trigger point decompression surgery involves a minimally invasive approach to the nerves in the head and neck region that cause or contribute to the headache symptoms. The trigger point sites are “relieved” by meticulously removing muscle, fascia (tissue lining) and blood vessels from the areas in which the nerves travel. The process of releasing the trigger points is called “trigger point surgery” or “nerve decompression surgery”. The trigger point sites are “relieved” by meticulously removing muscle, fascia (tissue lining) and blood vessels from the areas in which the nerves travel. The goal, in most cases, is to preserve nerve function while eliminating the source of nerve irritation. Multiple trigger point sites can safely be addressed in one procedure. The number of trigger point locations to operate on is based upon each patients’ symptoms, and in which locations Botox® therapy has been previously effective.
The techniques utilized in this procedure are based upon well-established methods that have been around for several decades. A simplified version of these methods is used in carpal tunnel surgery, whereby the nerve to the hand is relieved of compression to reverse numbness and weakness in the fingers.
Trigger point decompression surgery is performed in an outpatient setting and is considered minimally invasive (small incisions in the front and/or back of the head, sometimes with the aid of an endoscope). The surgery is performed under general anesthesia and typically takes anywhere from 1 to 3 hours. The recovery time from trigger point decompression surgery is generally 7 to 10 days. Patients must have had a recent exam by a neurologist and MRI in order to qualify. Please contact our office for a free consultation to find out more about these exciting new treatments.
BOTOX® is already approved by the FDA to treat uncontrolled blinking; crossed eyes; certain neck muscle spasms; excessive underarm sweating; and stiffness associated with muscle spasticity in the elbows and hands. It also is approved for cosmetic purposes — to smooth lines between the eyebrows. The same formulation of BOTOX® used for migraine headache treatment was approved by the FDA in 2002 for the treatment of facial frown lines.
Botox® acts to block receptors that control muscle contraction, thus relaxing or paralyzing muscles. It is theorized that in regions of certain migraine “trigger points”, nerves are compressed or irritated by excessive muscle contraction. These irritated nerves release inflammatory chemicals into the blood vessels of the head and neck that may contribute to chronic migraine headaches. By relaxing the muscles in one or more areas of nerve compression, the source of nerve irritation is alleviated, and the resulting migraine will be reduced or eliminated. While this theory underlies the rationale for treating migraine headaches with Botox®, no one is actually sure of the mechanism by which migraines occur.
If you suffer from migraine headaches more than 15 days per month, The Plastic Surgery Center/The Institute for Advanced Reconstruction’s board-certified plastic surgery specialists provide Botox® injections to alleviate the debilitating pain of migraine headache. The FDA-approved (as of Oct. 2010) approach to migraine treatment involves administering injections around the head and neck at intervals of about 12 weeks. With Botox® for migraines, you can reasonably expect fewer, less severe migraine headaches for up to three months, with rarely any side effects. However, the FDA says Botox® does not appear to be useful in treating or preventing less frequent migraines that occur 14 days or fewer per month or other forms of headache.
Since 2005, we have been using Botox® at The Institute for Advanced Reconstruction to treat patients (more than 100 to date as of 3/2014) with either occipital neuralgia or migraines, and have often observed very favorable responses to treatment. Many patients are able to reduce or eliminate their need for medical therapy.
For more information on Botox® Treatment for migraine headaches, please see Dr. Kaufman’s blog post here.
Although Botox® injections must be repeated at regular intervals, many patients have reported a greater than 50% reduction in the frequency and intensity of their migraine headaches. Some patients have even noted a complete elimination of migraine headaches altogether. In our practice, patients have reported major reductions or complete elimination of migraine headaches after treatment with Botox®.
Certain types of migraines and headache conditions respond to Botox® better than others. Only a physician experienced in treating migraines with Botox® will be able to determine if someone is a candidate for this type of treatment. Contact The Institute for Advanced Reconstruction at The Plastic Surgery Center for a consultation to determine if Botox® is the right treatment for you.
Unfortunately, not everyone benefits from Botox®. It is our belief that migraine sufferers represent a very diverse group of patients, and due to the complexity of the condition, we sometimes see patients who do not experience any effect from injection therapy. Conversely, in patients with confirmed occipital neuralgia, we rarely see a patient who does not report some improvement from Botox®.The reason behind this may be connected to the fact that occipital neuralgia is a condition that is primarily due to “nerve trigger points” as opposed to migraines, in which the underlying problem may be due to a combination of factors.
Accordingly, the IHS specifically describes occipital neuralgia as a condition in which “pain is eased temporarily by local anesthetic block of the nerve.” This supports the notion that the symptoms are primarily due to a “nerve trigger point” problem, as local anesthesia works on nerves to temporarily deaden them.
Many of our occipital neuralgia patients report the onset of the condition following a traumatic event, such as a car accident or fall. A whiplash injury that causes inflammation in the head and neck region may result in the occipital nerves becoming sites of these “trigger points”. Patients with this type of history tend to respond the best to injection therapy, or even to trigger point decompression surgery.
If you are suffering from migraine headaches or occipital neuralgia and are exploring treatment options, please contact us for more information and to schedule a consultation.