Migraine headache treatments fall into several different categories, including medication, injection, “alternative treatments”, and migraine surgery. At our migraine headache surgery center, Dr. Lowenstein performs diagnostic nerve block injections for the purpose of diagnosis and to evaluate if the patient is a candidate for surgery. Most migraine and tension headache patients are good candidates for outpatient migraine surgery. These diagnostic nerve blocks confirm that this short outpatient operation will likely provide long term pain relief for migraine and headache sufferers.
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. Surgery is usually utilized in patients who are unable to control their symptoms with non-surgical migraine headache therapy, or for one reason or another would prefer a surgical option to a medical one.
There are a few options for injection therapy for migraine headaches, though the principle two techniques utilize Botox or local anesthesia (lidocaine). In 2010 the FDA approved the use of Botox injection to prevent headaches in chronic migraine patients, and in these patients, Botox is often given as multiple injections around the neck and head. The recommended dosing distributes 155 units of Botox divided into 31 different sites, and Botox is routinely successfully used by neurologists and pain control physicians.
When performed by Dr. Lowenstein, these injections are done differently. Dr. Lowenstein performs diagnostic nerve blocks in patients who present to the office with headache pain. These injections provide temporary relief but allow Dr. Lowenstein to pinpoint the cause of the patient’s headache pain, and show us that these patients are good candidates for migraine surgery. If you have a headache when you come to see Dr. Lowenstein, the nerve block is performed with local anesthesia. This injection with Lidocaine and Marcaine can produce immediate though temporary results, indicating that you would be a great candidate for migraine headache surgery.
Patients who don’t present to the office with a headache may be treated with Botox using specific point injections to see if there is a reduction in migraine headache symptoms over the course of 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 such as these with Botox and/or local anesthesia do not demonstrate any relief of symptoms, you may not be the best candidate for surgery. In these cases, Dr. Lowenstein may recommend a second attempt to make certain that you are not responding. Patients who do not respond to the injection of these nerves should continue to be followed by their neurologist or medical headache specialist.
Medications are excellent options for many patients who respond to these modalities. Neurologists, pain management physicians, and other medical specialists have had variable success with migraine headache patients for many years.
Medications can be classified into those that try to prevent the onset of a headache and those that try to abort 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 anti-depressants, anti-seizure drugs, and blood pressure medications can be used to try to prevent headaches from starting. New migraine medications target pain receptors in the brain (Aimovig, Emgality, and others) and can be very helpful in some patients. The high cost, side effects, and variable success of these drugs can limit their helpfulness.
Unfortunately, another class of medication that is sometimes needed to control pain is narcotics, also called opioids. These medications are addictive and can ruin lives unto themselves, inducing 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 advantages in the use of migraine headache surgery is the ability of migraine headache patients to cut down on if not completely stop the use of medications and opioids in particular.
Many different non-traditional therapies have been successfully utilized 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 provide excellent relief of pain in many cases. 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 are indicated when less invasive treatments are unable to provide adequate or lasting relief.
Outpatient migraine headache surgery is an effective and long term solution for chronic migraine headaches that are inadequately treated by more conservative means. Patients who are candidates for migraine headache surgery have frequent and/or continuous headache symptoms, ranging from pain to lightheadedness to photosensitivity or nausea.
Surgery for migraines and other types of 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 headache syndromes. By removing the irritating tissues around these nerves, the distress signals that produce the headache symptoms are never produced, and never reach the brain to cause any of the 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 office for questions that you may have regarding the permanent improvement of your migraine and headache pain.
To learn more about migraine treatment, please call 805.969.9004 to schedule a consultation with Dr. Lowenstein, at our offices in Los Angeles, Denver, and Santa Barbara, CA. Your consultation with an experienced migraine surgeon is a meaningful step toward your overall health.
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