Nerve Decompression Surgery for Migraine Headache
Dr Doumit, a world renown plastic and cranio-facial surgeon, offers surgical treatment of migraine headache in Montreal
Migraine headaches affect an estimated 12% of the US population. Every year 28 million patients suffer from migraine headaches. Migraine headache is a major burden on the patients: Collective loss of 112 million workdays, $14 billion in productivity /year. Cost of Medications is $ 1.5 billion.
How is MIGRAINE HEADACHE diagnosed?
Diagnosis of migraine headache is made by a neurologist. The International Headache Society published guidelines to help the neurologist make the diagnosis.
A patient must have:
- At least 5 headache attacks lasting 4 – 72 hours
- Has at least two of the four following characteristics:
- 1. Unilateral location, 2. Pulsating quality, 3. Moderate or severe intensity, 4. Aggravated by routine physical activity
Je me suis fais faire la chirurgie curative de la migraine par le Dr Doumit en mai 2016. Cela fait maintenant plus de 3 mois, et mes maux de tête ont diminué de 80%. Je suis très satisfait du résultat et ses services du Dr Gaby Doumit. D Plante
What Factors trigger Migraine Headache?
Foods: Aged cheeses, Chocolate, Caffeine, Processes Meats, Alcohol, Aspartame, Nuts, Smoked Fish, Avocados, Onions, Tomatos.
Medications: Antibiotics, Antihypertensives, HRT, SSRI, Vasodilators, Oral Contraceptives, Nitrates, Decongestants, Benzodiazepine
Environmental: Flashing lights, Bright lights, fluorescent lights, strong odors, weather changes, high altitudes, pollution, travel
Lifestyle: Emotional stress, sleep disturbances, overexertion, menstruation, menopause, caffeine withdrawal, fasting, oversleeping.
What is the exact cause of Migraine Headache?
The exact cause of migraine headache is still largely unknown.
There is many theories.
1- Central Nervous System Disorders - genetic predisposition, hyper excitable brain (lower threshold for occipital cortex excitation)
2- Minor Vascular changes - oligemia begins in occipital cortex, spread forward 2-3 mm/min. Aura phase: Spasm of Cerebral arteries; Headache Phase: vasodilation of cerebral arteries.
What is the surgical treatment of Migraine Headache?
Surgical treatment of migraine headache consists of decompression of small nerves in the forehead and or back of the head. Nerve decompression leads to reduction of peripheral sensory neurons input (trigeminal nociceptive system). It leads to indirect reduction in central sensitization.
The nerves and sites decompressed in migraine surgery are:
- Supra-orbital / Supra-trochlear Nerves
- Corrugator supercilli, depressor supercilli
- Zygomaticotemporal nerve
- Temporalis muscle
- Greater occipital nerve
- Semispinalis capitis muscle
- Nasal septum deviation with enlargement of the turbinates
Who is the Best Surgical Candidate for Migraine Headache?
The best patient for surgical treatment of migraine headache has the following characteristics:
1- Diagnosis of Migraine Headache (Made by a Neurologist)
2 - PATIENT IS CLEARLY ABLE TO IDENTIFY THE SITES FROM WHICH THE HEADACHE ORIGINATE. IDEALLY ABLE TO PINPOINT THE ONSET OF LOCATION OF THE HEADACHE WITH A SINGLE FINGER.
Supra-orbital / Supra-trochlear Nerves
Greater occipital nerve
Before & After Photos
* Disclaimer: Those pictures represent real patients operated by Dr. Doumit. However, Patients results undergoing plastic surgery can vary from one to the other depending on multiple factors.
What is the Success of surgical decompression of Migraine Headache?
Dr Guyuron et al published a key article on the success of migraine headache. In his study, Dr Guyuron found that 57% of patient who underwent surgical decompression obtained complete elimination of Migraine Headache vs 3.8% for the placebo (no treatment group).
- 28/49 (57%) treatment group vs. 1 /26 (3.8%) control group
- P <0.0001
- Partial elimination (> 50%) of Migraine Headache
- 41/49 (84%) treatment group vs. 15 /26 (58%) control group (Sham surgery)
In a recent publication, the authors reviewed all publications in the world. 8.3% - 63.2% of patients had complete elimination of pain after decompressive migraine surgery while 68% - 100% had improvements.
For RAMQ patients please see Dr Doumit at CHUM - Notre Dame Hospital.