Treatment for Migraine Headaches
Migraines are one of the oldest infirmities known to humankind. Their treatments can be traced back 9,000 years ago when evidence shows that holes were drilled into skulls (actually a nonfatal process) to allow the escape of evil spirits.
The history of headaches includes a long list of experimental treatments similar to this example. Even today, experts agree there is a lot of trial and error in migraine treatment despite the advancements of modern medicine.
That being said, there are some tried-and-true treatment options used today, and they fall into the following categories: medication, non-invasive techniques, lifestyle adaptation and surgery.
Medications are probably the most common treatment and fall into several categories themselves: pain-relieving, preventive and symptom-relieving (such as nausea or vomiting). Daily antidepressants have also been shown to reduce migraine occurrence. Administration of medications depends on the frequency and circumstances of the headaches. While medications can be helpful, they may be limited in their overall effectiveness or in the length of time in which they are effective. They may also present challenges, such as drug intolerance or allergy. Ironically, the overuse of some of these medications may result in headaches, as well.
Other therapies or treatments for migraines include but are not limited to:
- Dietary adjustments (e.g., eliminating food-related headache triggers)
- Stress management
Treatment for Migraines
The International Headache Society (HIS) definition of common migraine (now referred to as migraine without aura) states:
Recurrent headache disorder manifesting in attacks lasting 4 to 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).
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, 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.
In October 2010, 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.
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® blocks 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 Institute for Advanced Reconstruction’s board-certified plastic surgery specialists provide Botox® injections to alleviate the debilitating pain of migraine headache. The FDA-approved 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 (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 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 percent 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.
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.
Contact The Institute for Advanced Reconstruction for a consultation to determine if Botox® is the right treatment for you.
Migraine Headache Surgery
As an intended permanent way of reducing or eliminating migraine headaches, a surgical procedure known as “trigger point surgery” or “nerve decompression surgery” is offered to those patients who benefit from Botox® therapy. It stands to reason that our 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 since the early 2000’s, 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. Hence, the process of releasing the trigger points is called “trigger point surgery” or “nerve decompression surgery”.
In most cases, the goal 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 patient’s 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 one to three hours. The recovery time from trigger point decompression surgery is generally seven to 10 days. Patients must have had a recent exam by a neurologist and MRI in order to qualify.
Q & A with Dr. Kaufman
Q: What are the difficulties in dealing with migraines?
When it comes to migraines, there are many challenges. To begin with, the diagnosis is often complicated because there are various types of headaches. Plus, a migraine can be the condition itself, the result of another condition or the symptom of a serious illness. Great advances have been made, but we still need a better understanding of the issues involved from the perspective of science and the perspective of symptom relief. We also need to enhance patient education, so they learn how to adequately recognize and deal with their condition.
Q: What are the various types of headaches?
There are actually upwards of 150 types of headaches. Tension or stress headaches are the most common followed by migraines. Other types include occipital neuralgia, post-traumatic headache, and cervicogenic. Our breakthrough treatments apply to all of these.
Q: What is occipital neuralgia?
In occipital neuralgia, the occipital nerves that run from the top of the spinal cord up through the scalp are injured or inflamed, which is what causes the painful headache symptoms. In addition to pain, these headache sufferers can feel tenderness or diminished sensation around the area of the nerve.
Q: What is the difference between occipital neuralgia and migraine headaches?
While occipital neuralgia causes a jabbing pain in the area of the occipital nerve, migraines are characterized by recurrent headaches lasting 4-72 hours. Occipital neuralgia causes similar problems to migraine headaches, but may respond very differently to certain forms of treatment. Neurologists and other headache specialists sometimes have difficulty diagnosing the headache condition as one or the other, and there may be overlap in the classification. The bottom line is that there are 28 million migraine sufferers in the United States, one-third of whom find little or no benefit from traditional medical therapies.
Q: What are the differences in treatment for the two conditions?
Both occipital neuralgia and migraine headaches are initially treated with medication in an attempt to reduce symptoms and prevent their reoccurrence. Unfortunately, many medical approaches stop working over time. In addition, often these medications have side effects that can disrupt patient’s lives in unpleasant ways. Botox® injections can be helpful in treating both types of headaches, depending on each patient’s specific condition, and are particularly helpful for occipital neuralgia.
Q: What surgical options are available for these types of headaches?
If patients benefit from Botox® therapy, Nerve Decompression Surgery is offered as a permanent way of reducing or eliminating headaches. This treatment is available at only a limited number of locations in the United States, with The Institute of Advanced Reconstruction being one of them. We have been performing this surgery since 2005 with tremendous success, especially in patients with occipital neuralgia.
Q: Can you describe Nerve Decompression Surgery?
This surgery involves a minimally invasive approach to the nerves in the head and neck region that cause or contribute to headache symptoms. The nerve sites are relieved when the surgeon removes muscle, tissue lining, and blood vessels from the areas in which the nerves travel. Multiple trigger point sites can safely be addressed in one procedure. The number of locations on which to operate depends on each patient’s symptoms, and in which locations Botox® therapy has been effective.
Q: Is Nerve Decompression Surgery successful in reducing symptoms?
Some of our patients have essentially been “cured” of their condition. This means they no longer need medical therapy and rarely, if ever, have a headache. Though each individual case varies, if you suffer from occipital neuralgia there is a good chance your symptoms would be helped by either Botox® or surgery.