Migraine headache is a common form of headache that affects over 29 million people. 75% of those affected are women. Children are also affected. The treatment for migraine headaches have been several oral or injectable medications which have offered some relief to these patients but are also associated with side effects which may interfere with patients’ daily functions. Patients’ response to current treatment is variable and not definitive. They may have short term relief with exacerbation of their symptoms without warning. This may occur even in a very compliant patient. The cost of migraine headache has been estimated to be in billion of dollars per year and the out of pocket cost secondary to deductible, co-payments and the Emergency Room cost could be $1000 per month not to mention the loss of wages due to work loss.
Plastic surgeons have observed that patients who had BOTOX® for improvement of wrinkles in the frown and forehead areas had less migraine headaches. This was also observed in patients who have had forehead lift which also involved release of muscles in the frown area. This observation led to further research into the possibility of muscular compression of sensory nerves of forehead and scalp as the culprit for migraine headache development. Surgical decompression of affected nerves, have shown that approximately 86% of patient had permanent relief of their symptoms. BOTOX® treatment of the appropriate nerves, which we call Chemical Nerve Decompression can relief migraine headache for approximately 4-6 months depending on the individual patient.
After a complete history of physical examination, once determined the headache or facial pain is the result of migraine headache, the trigger points which are specific areas where the nerves exit face and scalp are treated with BOTOX®. There are 12 points at which these nerves exit the scalp and forehead. The treatment of specific nerve depends on patient’s symptoms. For example, some patients have pain that initiates from back of the head and travels forward to frown area or vice versa. In others, the pain starts at the right or left temple and involves the eye at the affected area which may include watery eye and blurry vision. Therefore, the frown and forehead nerves ( supratrochlear and supraorbital ) as well as the occipital nerves ( greater, lesser and third ) are treated in the former case while in the latter, the temporal nerve ( zygomaticotemporal ) is treated.
Treatment of Migraine Headache / Chemical Nerve Decompression
Numerous anatomic studies have determined, within millimeters, where these nerves exit the scalp and we accurately measure these exit sites for each nerves that we treat using the anatomical landmarks in the head and neck to pinpoint the area to be injected. BOTOX® is then injected into the surrounding muscle which achieve its paralysis in 3-4 days and relief of migraine headache symptoms. The effect of BOTOX® can last up to 3-4 months, at which point, the treatment is repeated.
Majority of our patients will achieve complete resolution of their symptoms and slowly begin to reduce their migraine medicine intake under care of their treating doctor. These patients usually are taking several medications and are relieved to know they do not have to suffer and put up with their side effects.
Occasionally, patient may continue taking all or some of their medications for the fear of recurrence of their migraine headache symptoms. After two or three Chemical Nerve Decompressions with BOTOX®, they will stop their migraine medication.
Surgical Treatment of Migraine Headache / Surgical Decompression of Nerves involve in Migraine Headache
Surgical treatment of migraine headache, involves the release of the compression of the specific nerve/s causing the migraine headache which is determined by accurate patient history e.g. if the headache starts at the frontal area between the eyebrows, then the nerves in that area is decompressed. When two or more nerves are involved, then both nerves can be decompressed at the same time. In one recent study, 86% of the Patients who have had nerve decompression surgery achieved improvement of their symptoms and 56% had complete resolution.
Call us at 714-596-2660 for a complimentary appointment and find out what we can do for you. It may be a “life altering experience”. That is what our migraine patients tell us.