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 injections for the purpose of diagnosis and to evaluate if the patient is a candidate for surgery. Routine injections, medications, and alternative therapies are outstanding 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.

Injection Therapy for Migraine Headaches

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 used by Dr. Lowenstein, these injections may be done differently. Used in some regions of trigger points, patients who don’t present to the office with a headache may be treated with Botox using 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 you have a headache when you come to see Dr. Lowenstein, he may perform a nerve block with local anesthesia. This injection with Lidocaine and Marcaine can produce immediate though temporary results, again indicating that you would be 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 injection of these nerves should continue to be followed by their neurologist or medical headache specialist.


Medications for Migraine Headaches

Medications are excellent options for many patients who respond to these modalities. Neurologists, pain management physicians, and other medical specialists have had great success with migraine headache patients, and even in cases where surgery is a great option Dr. Lowenstein strongly urges his patients to followup with their medical headache specialist.

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.

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.


Alternative Therapies for Migraine Headaches

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 very 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.


Surgery for Migraine Headaches

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. A series of nerve blocks may be utilized to assure that migraine surgery is right for you.

FAQs: HEADACHE TREATMENT OPTIONS

  • Which treatment is right for my migraines?

    There is no easy answer to this question. Nerve blocks vs botox vs 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 stop long term improvement may choose surgery. If your lifestyle does not currently lead itself to allow for postoperative recovery, Botox may be a short term answer until your personal situation turns into one that allows a more permanent surgical intervention.
  • Is Botox ever used at the time of surgery?

    Not usually. Migraine surgery effectively does “mechanically” what Botox does “chemically”. In other words, as Botox injections relax 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 you can, but only if necessary. Many migraine surgery patients have complete resolution of their pain after their operation, and other modalities are no longer needed. Some patients have a significant improvement but still have occasional headaches, and there is no reason to avoid other treatment modalities if patients wish to continue with them, as long as the surgical site is allowed to properly heal first.
  • Can I take my migraine medication after surgery?

    Absolutely you can take medication for your headaches after surgery, though our goal is to make it so you no longer need any migraine medication at all. As we go over elsewhere in our website, some patients will continue to have good days and bad days following their migraine surgery while the nerves recover from the surgery themselves. While many patients are completely pain free immediately after surgery, those patients who still have headache pain are encouraged to treat them medically as the nerve inflammation subsides.

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