If you suffer from migraines, you know how physically painful and debilitating they can be once they start. Even worse, most patients who deal with chronic migraines are at a loss to understand where they come from and what they can do to prevent them and often feel hopeless. Luckily, there are many migraine treatment options that have had successful results for patients who seek migraine relief.

Migraine headache treatments fall into several different categories: medication, injection, alternative treatments and migraine surgery. More traditional migraine and headache treatments include various medications, while alternative therapies such as acupuncture are other ways that many patients can manage their migraine headache pain.

Migraine surgery is a short outpatient operation that is recommended for patients who are unable to control their symptoms with non-surgical migraine headache therapy or for those who would prefer a surgical option over other treatments.

At Migraine Surgery Specialty Center in Santa Barbara, board-certified plastic surgeon Dr. Lowenstein can perform diagnostic nerve block injections for patients who wish to be diagnosed and evaluated to determine if they are a candidate for migraine surgery.

Most migraine and tension headache patients are good candidates for outpatient migraine surgery. However, these diagnostic nerve blocks can confirm if migraine surgery will provide long-term pain relief for migraine and headache sufferers.

Medications for Migraine Treatment

Medications are excellent options and one of the first to be tried for many patients who suffer from migraines. Neurologists, pain management physicians and other medical specialists have successfully treated migraines with medications for many years.

Medications can be classified into those that try to prevent the onset of a headache and those that try to stop a headache once symptoms begin. Medications such as ergots (DHE) and triptans (Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig) are used to try to stop migraine headache symptoms once they have started.

Other drugs, such as antidepressants, anti-seizure drugs and blood pressure medications, can be used to try to prevent headaches before they start. New migraine medications such as Aimovig and Emgality target pain receptors in the brain and can be very helpful in some patients. However, the high cost, side effects and unreliable success of these drugs can limit their helpfulness.

Unfortunately, another class of medication that is often prescribed to control migraine pain is narcotics, also called opioids. These medications are addictive and can cause more harm than good, leading to addictive behaviors, hospitalizations and even deaths. The Department of Health and Human Services estimates that in 2014 the economic impact of the opioid epidemic was 55 billion dollars.

One of the main reasons patients seek out migraine surgery with Dr. Lowenstein is to cut down, if not completely stop, the use of medications and opioids in particular.

Injection Therapy for Migraine Treatment

There are a few options for injection therapy for migraine headaches. The two most popular injections for migraines are Botox and local anesthesia (Lidocaine and Marcaine). In 2010 the FDA approved the use of Botox injections to prevent headaches in chronic migraine patients. In these patients, Botox is often given as multiple injections around the neck and head. Neurologists and pain control physicians have successfully used Botox in the treatment of migraines.

If you have a headache when you come to see Dr. Lowenstein, he will perform a nerve block with local anesthesia. This injection with Lidocaine and Marcaine can produce immediate, though temporary, results. If you feel relief from your migraine, this indicates that you would be a great candidate for migraine headache surgery.

Patients who don’t come into the office with a headache may be treated with Botox using injections at specific points to see if there is a reduction in migraine headache symptoms over the next few weeks to months. If your migraine headaches respond to Botox in this injection technique, you are likely a great candidate for migraine headache surgery.

If injections with Botox or local anesthesia do not relieve your migraine symptoms, you may not be the best candidate for surgery. In these cases, Dr. Lowenstein may recommend a second attempt to ensure that you are not responding. Dr. Lowenstein recommends that the few patients who do not respond to the injection of these nerves should continue to follow up with their neurologist or medical headache specialist.

Alternative Therapies for Migraine Treatment

Many different non-traditional therapies have been successfully used to treat migraine headache patients. Acupuncture, biofeedback, massage, lifestyle and dietary changes can all have a positive effect on migraine headache symptoms. Chiropractic care can also provide excellent relief of migraine pain in many patients.

If these therapies are able to control your migraine headaches, Dr. Lowenstein encourages you to continue with these regimens. Surgery for migraine headaches and occipital neuralgia is only recommended when less invasive treatments are unable to provide adequate or long-lasting relief.

Surgery for Migraine Headaches

Outpatient migraine headache surgery is an effective and long-term solution for chronic migraine headaches that are inadequately treated by other means. Patients who are candidates for migraine headache surgery have frequent or continuous headache symptoms, ranging from pain to lightheadedness to photosensitivity to nausea.

Surgery for migraines and other headaches centers around removing irritation from superficial peripheral nerves in the head and neck. Irritation of these nerves sends distress signals to the brain, causing the pain and symptoms of migraines and other headaches.

By removing the irritating tissues around these nerves, the distress signals that trigger headache symptoms cannot be produced and never reach the brain to cause any migraine or headache symptoms. Migraine surgery has been shown to help over 90% of patients who undergo this short outpatient procedure.

It is important to remember that migraine surgery is NOT BRAIN SURGERY. Dr. Lowenstein performs migraine surgery as an outpatient procedure that is well-tolerated, highly effective and has little risk or side effects.

Contact our Migraine Surgery Specialty Office in Santa Barbara for questions that you may have regarding the permanent improvement of your migraine and headache pain.

Patient Testimonial

Before I met Dr. Lowenstein I had seen over 30 doctors in a multitude of specialties. None of them knew how to address my chronic pain or help me. After surgery, I didn’t have the pain anymore and I feel like ME again!! I feel like I have my life back. Thank you!

– C.M.


Which migraine treatment option is right for me?

There is no right answer to this question. Nerve blocks, Botox and migraine surgery are used in different patients for different reasons. Patients hoping to avoid surgery who are ok with repeated Botox injections may choose to go this route for a long-term treatment plan. Other patients who are interested in a one-time, long-term improvement may choose surgery.

If your lifestyle does not currently allow for postoperative recovery, Botox may be a short-term answer until your situation is better suited for a more permanent surgical intervention.

Can I take my migraine medication after surgery?

Absolutely! You can continue to take medication for your headaches after surgery, though our goal is to make it so you no longer need any migraine medication at all. Dr. Lowenstein tells his patients that they will continue to have good days and bad days following migraine surgery while the nerves recover from the surgery themselves. As postoperative swelling subsides, your need for other medications and therapies should decrease substantially or go away completely.

While many patients are completely pain-free immediately after surgery, those who still have headache pain are encouraged to treat them medically as the nerve inflammation subsides.

What if Botox has not worked for me?

If Botox has not helped you in the past it does NOT mean that you are not a good candidate for migraine surgery. Botox works by relaxing the muscles around your nerves that may be pushing on and irritating these nerves. If the irritation is not from muscle but instead from connective tissue or blood vessels or lymph nodes or even bone, Botox will have no effect on your pain because these other compressive structures don’t respond to Botox. A nerve block by Dr. Lowenstein may (and likely will) still show that nerve decompression can help your pain providing long term relief.

Is Botox ever used at the time of surgery?

Not usually. Migraine surgery physically does what Botox does chemically. In other words, as Botox injections relax the muscle around the nerve by preventing that muscle from contracting, the surgical procedure actually disrupts that muscle on a more permanent basis, so further Botox injections are not necessary.

Can I have acupuncture or chiropractic following my surgery?

Absolutely, although it may not even be necessary. Most migraine surgery patients no longer experience migraines after their operation, and other migraine therapies are no longer needed. Some patients have a significant improvement but still have occasional headaches, and there is no reason to avoid other treatments if patients wish to continue with them, as long as the surgical site is allowed to properly heal first.

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