migraine surgery risks and benefits

To some degree, the benefits of migraine surgery go without saying. Imagine being free of head and neck pain. Imagine being able to interact with family and friends, going to work and being productive, and doing all of this without having pain or worrying that a migraine headache is going to come and ruin your day. In nearly 40% of cases, patients who have migraine surgery become completely free of headache pain.

For other patients who undergo migraine headache surgery, there is a significant reduction in the frequency of headaches, as well as the severity of headaches. What would it be like to take Tylenol or Advil for a headache, like everyone else, and have it actually work???? About half of the patients who have nerve decompression surgery for migraines and occipital neuralgia find that although they still do sometimes get headache pain, the episodes are felt less than half as often as they did before surgery, and more importantly… the pain is nowhere near as bad as it used to be. If your bad head and neck pain is currently a level 10 out of 10 15 days a month, what would you think if that could become a level 5 out of 10 only 7 times a month? Even for these patients with less than perfect results, the ability to rejoin life and spend more time with family and friends is remarkably wonderful.

For patients in whom the pain resolution is not complete, there are incredible changes that often occur after surgery. Nearly all patients who have migraine surgery are able to get off of narcotics. That means no more Percocet, Norco, Dilaudid, Morphine, or other narcotic pain prescriptions that need to be ordered by a doctor. No more Emergency Room visits. No more being called a drug seeker or narcotic addict. For these patients who still have occasional migraines after surgery, normal migraine medications that never worked in the past often will work well. For most, over the counter headache medications are all they will ever need again after migraine surgery.

About five to ten percent of the time, migraine surgery is not successful. This means that only one in ten to twenty patients who have surgery for their migraines or occipital neuralgia don’t get better. For some patients, simply decompression of the nerves just is not enough, and these patients may need to return to the operating room to have their nerves cut. Dr. Lowenstein rarely cuts principal nerves during the first operation because of the remarkably high success rate we see with nerve decompression. If decompression does not work, however, dividing the nerve may be an option.

migraine surgery risks and benefits

Some patients who undergo nerve decompression migraine surgery have “unmasking” of pain in other areas. What this means is that if the majority of your pain is coming from the occipital nerves, and a lesser pain is coming from the supra-orbital nerve, you may not really be noticing the supra-orbital pain because of the severity of the pain caused by the occipital nerve issues. Surgery to decompress the occipital nerve pain may be entirely successful, relieving all pain from the neck and back of your head, but this might allow you to realize your supra-orbital pain now that the main source of discomfort is gone. This is termed “unmasking” of a pain source that had not been significant enough prior to relieving symptoms from another nerve source.

Many patients who have unmasking of pain from secondary nerves are candidates for decompression from that new source and can achieve complete pain resolution. Many times, however, the “unmasked” pain is so much less severe than the pain that was fixed with the migraine surgery, that patients don’t feel compelled to have another operation. The choice is always, of course, left to the patient to decide.

Rarely a cut nerve can form a neuroma, or nerve scar tissue that can be painful and require reoperation. Because there are specific techniques in surgery that help prevent neuroma formation, this is a very rare risk of surgery. Dr. Lowenstein buries any cut nerves into muscle tissue, and this helps prevent neuromas. This important step for all cut nerves is well known to most experienced nerve surgeons.

Following migraine surgery, the nerves that have been decompressed may be in shock. The manipulation from surgery combined with normal swelling associated with healing may cause the nerves to be irritated for some time while the operative site settles down. This may cause “ups and downs” for the first few weeks or even months after surgery. Patients with occasional “flares” of headache pain after their operation are still likely to have a good long-term result following the resolution of the normal healing process, but these good and bad days should be expected following migraine surgery.

Very rarely, when nerves do need to be cut (so that is a rare situation upon a rare situation), the area of skin that the nerve gives sensation to retains an uncomfortable sensation that patients do not like. While this has never happened to any of Dr. Lowenstein’s patients, there have been reports of postoperative patients who are not tolerant of the numbness and tingling, sometimes perceived as pain, that can result in these situations. When Dr. Lowenstein performs targeted nerve mapping (TIM) using nerve blocks, the same numbness can be felt for an hour or two while the screening nerve block is in effect. During the nerve block, patients are asked to realize that a cut nerve will likely mimic this feeling of a nerve block, so there is an understanding of the sensation that can occur in the very rare incidence that this occurs after surgery.

While Dr. Lowenstein has never seen this happen, he will always say that there is a chance that the pain might get worse after surgery rather than better. Pain is a very subjective thing, and though it has never happened at Migraine Surgery of Southern California, we always want our patients to understand the extremely rare risks of the surgery they are having, as well as the vastly more common benefits of reducing or eliminating migraine headache pain forever.

Overall, migraine surgery is very safe, very well tolerated, and very effective. All told, over 90% of patients get significant or complete relief from their pain. What would it be like, and how would your life change if you no longer had to worry so much about your pain?

Testimonials

This was the BEST thing I’ve ever decided to have done. It was not an easy decision but thought my life was over. I was considering filing for disability because I was barely hanging
on at work. Not only was the surgery a success but I couldn’t have asked for a better doctor to have performed my surgery. I’m so glad I found you and had this surgery performed. It’s
been life changing.

-MN

Dr. Lowenstein gave me my life back. I had [decompression of occipital nerves on both sides]. I can really smile, thank you all.

-AV

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