Migraine Headaches

The term “migraine headache” is often used as a catch-all phrase to describe a severe and sometimes debilitating headache. Eighteen percent of adult women and six percent of adult men suffer from migraine headaches, and over 3 MILLION cases of migraine headaches are diagnosed each year.

Migraine headaches are often accompanied by other symptoms such as photophobia (light sensitivity), nausea, vomiting, dizziness, sleepiness or sleeplessness, and often have specific triggers such as caffeine, alcohol, or stress. Visual disturbances may be associated with the onset of migraine headaches. Such visual symptoms may be flashes of light, regions of vision blurriness or blindness, or vague zig-zag patterns in your visual fields. These visual signs may be as signal that a migraine is about to start, and are often felt to be a window of opportunity for drug therapy to be started in order to abort the oncoming pain. Such medications may or may not be successful in the prevention of migraine headaches.

Migraine headaches may be of variable intensity with a variety of symptoms, and in fact pain may not be one of them. Some patients experience “visual migraines” alone where pain in the head never occurs, but their vision is impaired for a period of time. Other patients experience episodic dizziness without actual pain. Because of the variability of the migraine experience, definitive diagnosis and specific treatment regimens have often been difficult to obtain.

Migraine patients have often run through a great meany types of treatments which may include drugs, acupuncture, trigger avoidance, or other alternative therapies. Patients who have found success with these modalities are best maintained on these non-invasive measures. Research has found, however, that nerve irritation in several areas of the head and neck may be the causal factor which triggers the deeper migraine pain. In some cases, constrictive bands of tissue may be compressing the nerves, and in other cases bone or muscle may be pushing on the nerves, creating the pain. Often, a blood vessel adjacent to the nerve creates this pressure, and can be responsible for the “pulsating pain” that some migraine headache patients suffer from. Release of the effected nerves from these constrictions and pressures can provide improvement or even resolution from migraine symptoms.

FAQs: Migraine Headaches

  • What causes migraine headaches?

    While the exact cause of migraine headaches is incompletely understood, it is likely that there are several causal factors that can work alone or together to cause the severe headaches and accompanying symptoms that we term as a migraine headache. Because “migraine headache” is somewhat of a catch-all phrase for many different types of headaches, patients with migraines may in fact have varying causalities from occipital neuralgia to organic brain disease and in some cases even aneurysms or tumors. It is for this reason that patients with severe migraines should see an experienced physician and neurologist in order to be properly evaluated.

  • How are peripheral nerves related to migraines?

    Physicians have discovered that in many cases of severe headache, nerve compression at one of 14 known sensory nerves can be the root cause of discomfort. Compression and restriction of these nerves seems to provide a feedback to the pain centers of the brain to trigger the symptoms of migraines including pain, visual disturbances, dizziness, and other associated symptoms. These compressed nerves can become chronically inflamed or diseased over time which can create a chronic and recurring condition of recurrent or persistent headaches. By addressing these compressed nerves by releasing them from their restrictions or even cutting them in regions where they remain healthy, plastic surgeons have found that we can modulate and in many instances eradicate the painful feedback loop and improve or prevent severe headache pain.

  • Who should I see for my migraine headaches?

    Evaluation of your headache should begin with your primary care provider. Not all headaches are considered migraines, but diagnosis of a migraine can be a non-specific term encompassing many different headache types. Your primary care physician may treat you, or they may refer you to a neurologist, particularly if the first line of treatment is unsuccessful. Your workup may include a CT or MRI of the head to rule out tumor, aneurysm, or other pathology. Your neurologist may also involve a pain specialist in order to help control your symptoms if necessary.

  • Who should get an evaluation for migraine surgery?

    Patients that end up in our office have usually been seen by a primary care physician and neurologist, and may have been treated by pain physicians, chiropractors, other providers. Patients have often tried multiple different medications and may have had nerve stimulators or even previous surgery in the attempt to control their headaches.

  • I have had previous unsuccessful surgery. Do you do revision/re-operative surgery?

    Our experience has shown that while migraine surgery is not always successful, patients who have had migraine surgery elsewhere might have not had as extensive a release as we routinely perform. Patients who have had previous surgery for migraine headaches or occipital neuralgia may very well find improved relief following a second release at our Headache Center. Specific workup including an evaluation of previous treatments and surgeries is accompanied by specific diagnostic maneuvers to evaluate whether these patients are candidates for revision headache surgery.

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