With the understanding that some of his brow lift patients were reporting headache improvement, Dr. Bahman Guyuron began the investigation of the effect of nerve compression as a factor in migraine headaches. Dr. Guyuron’s further work ushered in the field of surgical nerve decompression for the treatment of migraine headaches. As the nerves above the orbits (eye sockets) were decompressed from the release of tissue here during brow lifts, other nerves have been identified as sources of migraine headaches when constricted. Subsequently surgical approaches to decompress these nerves have been developed, and the honing of these operations have provided migraine relief for thousands of patients. The nerves that we can address in the surgical treatment of migraine headaches include:
Each of these nerves have been identified as trigger points for migraine headaches. When constricted by surrounding tissue, these nerves become irritated and initiate the headache cascade producing pain and other migraine symptoms. Constriction of these nerves can be caused by several things.
These are headaches that are caused by dysfunction of the chemistry or anatomy of the brain. Because the skull is a hard and fixed encasement of the brain, any swelling of the tissue within the skull can cause pain. Dilation of blood vessels within the skull, or the growth of a lesion may increase the pressure on the brain and cause headache. Other central headaches are thought to be mediated by fluctuations in chemical mediators, such as serotonin which can have profound effects on mood and personality as well. On the whole, headaches that originate from a central source inside the skull are not amenable to this type headache surgery and require evaluation by a neurosurgeon
By surgically releasing the nerves from the surrounding constricting tissue, the nerves are allowed to conduct their business without the irritation that causes the symptoms of migraine headaches. Surgical release of the nerves listed above is associated with a success rate (defined as complete elimination of migraine symptoms or more than 50% decrease in the symptoms associated with migration headaches) in between 70% and 90% of patients, and complete resolution of headache symptoms in roughly 30% of patients who undergo migraine headache surgery.
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