Headaches are pains in the head, neck and scalp that vary in nature, symptoms and causes. The complex nature of headaches has led to a multitude of classifications and headache terminologies. Currently, there are 24 different types of headaches medically classified.

Globally, headache symptoms are some of the most common disorders in the nervous system. According to the World Health Organisation (WHO), around half to three-quarters of adults aged 18–65 years have had a headache in the past year. Additionally, around 4% of the world’s adult population have headaches for 15 or more days every month.

Patients who suffer from headaches may be diagnosed with one of many different underlying causes. Some headaches arise from “central” problems, which can range from tumors to chemical imbalances. However, most headaches are due to the compression of superficial nerves in the head and neck, which causes more profound pain in the head. It is these headaches that can be addressed with migraine headache surgery.

Headache Types

Stage 1: Prodrome Stage

During the Prodrome stage of a migraine, patients may feel tired, excited, irritable or even crave certain foods. These issues may or may not be recognized as migraine-related when they happen. For patients who do recognize these symptoms, this stage may be the ideal time to take an abortive medication.

Stage 2: Aura Stage

In the Aura stage of a migraine headache, the sensory aspects of the migraine begin to take shape. Most patients in this stage experience spots, flashes of light or a blind spot in their field of vision. Some patients report trouble speaking or thinking and difficulty concentrating.

Stage 3: Attack Phase

During the Attack phase, patients often experience headache pains. This pain is sometimes throbbing in nature and usually involves one side of the head. It can begin in the front or the back of the head and often moves towards other parts of the head. Other symptoms associated with the attack phase are nausea, vomiting and hypersensitivity to light and sound. In some cases, patients can lose the ability to use parts of their body (referred to as hemiplegic migraines).

Stage 4: Postdromal Phase

The last phase of a migraine is the Postdromal phase. Patients report exhaustion, confusion and often have a “soreness” of their head, similar to having a pulled muscle.

While these four stages are common, not all migraine patients will experience all four stages. Migraines can be acute, sporadic, chronic or even constant, and they can evolve over time.

Migraine headaches vary in intensity and symptoms. For example, some patients experience “visual migraines” in which their vision is impaired for some time, but there is no pain in the head. Meanwhile, other patients may experience episodic dizziness without actual pain. Because of the variability in the migraine experience, it’s often difficult to give a definitive diagnosis and specific treatment regime.

Migraine Causes

Many theories attempt to explain the causes of migraines. Some older theories believe that the migraine is a central brain disease. Meanwhile, recent research suggests that migraine headaches are often “peripherally mediated” – in which migraines are often triggered by the peripheral nerve rather than a central brain issue. These peripheral triggers send distress signals to the brain, which then cause the cascade of events that manifest into a migraine headache.

Research also suggests that migraine genes are coded in the DNA of many migraine sufferers. As a result, some of these patients may not have migraines until some seemingly small event triggers the migraines to surface. Conversely, other patients can have an onset of migraines from an early age for no apparent reason at all.

Peripheral nerve irritation in several areas of the head and neck are often the cause of deeper migraine pains. 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. In addition, blood vessels adjacent to the nerve often generate pressure and can be responsible for the “pulsating pain” of some migraine headaches.

Migraine surgery or “nerve decompression surgery” attempts to release the affected nerves from these constrictions and pressures and provide improvement and often resolution from migraine symptoms. For further information, read more about our pain-relieving surgery and our specialized care for our patients.

Our team at Migraine Surgery Specialty Center aims to provide you with the best service. For a more thorough discussion of your specific needs, please contact us or call our facility at 805-969-9004 for a consultation with our experienced surgeon Dr. Lowenstein.


How are peripheral nerves related to migraines?

In many cases of severe headache, nerve compression at one of fourteen known sensory nerves can be the root cause of discomfort. Compression and restriction of these nerves send feedback to the brain’s pain centers, which trigger the symptoms of migraines, including pain, visual disturbances and dizziness.

These compressed nerves can become chronically inflamed or diseased over time which can create recurring or persistent headaches. Plastic surgeons address these compressed nerves by releasing them from their restrictions or even cutting them in regions below the area of irritation. This procedure may eradicate the painful feedback loop and improve or prevent severe headache pain in many instances.

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 a migraine diagnosis can encompass many different headache types. Your primary care physician may treat you or refer you to a neurologist if the first line of treatment is unsuccessful. You may be asked to do a CT or MRI scan of the head to rule out a tumor, aneurysms or any other factors causing your headaches. Your neurologist may also involve a pain specialist to help control your symptoms if necessary.

Who usually comes in for an evaluation or a migraine surgery?

Patients who arrive in our office are usually referred by a primary care physician or a neurologist and may have been treated by pain physicians, neurologists, headache specialists, chiropractors and other providers. In addition, our patients have often tried multiple different medications and may have had nerve stimulators or even previous surgery in an attempt to control their headaches.

How do I know if I would benefit from migraine surgery?

Contrary to much of the management of headaches by medical doctors, figuring out if you are a good candidate for nerve decompression migraine surgery is very simple and straightforward. Dr. Lowenstein utilizes a screening protocol called Targeted Injection Mapping, or TIM. By targeting the nerve or nerves suspected to be causing your pain using a nerve block consisting of local anesthesia, Dr. Lowenstein can tell in minutes whether nerve decompression is likely to help your headache condition. Dr. Lowenstein’s high rate of success and patient satisfaction result not only from his techniques and his professionalism, but also from his patient selection. The TIM protocol is very effective in selecting the patients who are likely to benefit from surgery, and Dr. Lowenstein only operates on patients he feels will benefit from the procedure.

I have had previous unsuccessful surgery. Do you perform revision/re-operative surgeries?

Our experience has shown that while migraine surgery is not always successful, patients who have had migraine surgery elsewhere might not have had as extensive a release as we routinely perform. Patients who have had previous surgery for migraine headaches or occipital neuralgia usually find improvements following a second release at our Headache Center. Our specialized process involves evaluating previous treatments and surgeries accompanied by a specific diagnosis to evaluate whether patients are candidates for revision headache surgery.

Our team at Migraine Surgery Specialty Center provides specialized care for patients suffering from migraine headaches, and we aim to answer any questions or concerns you might have. For a more thorough discussion of your specific needs, please contact us or call our facility at 805-969-9004 to arrange a personal consultation with our experienced surgeon Dr. Lowenstein.

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