Comprehensive Care & Treatment for Migraine Headaches

The experienced plastic surgeons at University Hospitals use the latest surgical techniques to bring relief to patients who suffer from chronic migraine headache symptoms.

Surgical treatment of migraine headaches involves elimination of various trigger sites, including nerves of sensation in the forehead, temples, and back of the head. In addition, there are triggers points inside the nose that can also be addressed surgically.

Migraine Headache Symptoms and Diagnosis

A neurologist makes the initial diagnosis of migraine headaches. Patients with presumed nasal or sinus migraine triggers typically have several symptoms, which can include:

• Headache pain behind the eyes
• Early morning headaches
• Weather headaches
• Allergy headaches
• Hormone or period headaches
• Runny nose

Patient History and Examination

When a nasal or sinus trigger is suspected, a physician with expertise in nasal/sinus-triggered migraines does the patient evaluation. Questions asked may include:

• How frequently does the headache occur?
• Where does the headache begin?
• What resolves the headache?
• How intense is the headache?
• Is the headache related to weather changes?

In addition, questions are asked about nasal symptoms such as congestion/obstruction, sinus issues, previous nasal surgery, nasal trauma, the use of various nasal sprays or medications, and whether or not a patient has allergies.

The doctor will examine the outside of the nose and feel it for characteristics such as tip support. The inside of the nose is then examined with a bright light and an instrument called a speculum that gently opens the nostrils so the doctor can see inside. Often a small flexible fiber optic telescope is placed into the nostrils to get a better view far into the nose, looking for any abnormalities.

If a computed tomography (CT) scan or magnetic resonance imaging (MRI) has already been performed, the physician reviews it. Relevant findings are discussed with the patient. If scans have not been done, they are ordered by the physician to better establish the relationship between sinus or nasal problems and the migraine symptoms.

Surgical Treatment for Migraines

The best candidates for nasal/sinus surgery for migraine headache treatment are symptomatic patients who have a suspected relationship between headaches and structural or functional problems in the nose or sinuses. Ideal candidates are otherwise physically healthy, have realistic expectations, and are willing to accept the probability of success and the potential for complications.

Surgical treatment for migraine headaches is performed entirely through the nostrils and addresses the specific issues identified on physical exam or scans.

Each patient is different, and surgery may involve a surgical procedure on the septum, the nasal turbinates and/or the sinuses.

These surgeries are almost always done on an outpatient basis unless a patient has other medical problems, and is usually performed with a general anesthetic.

The length of the procedure is highly variable depending on what is done in the nose. Typically, surgery for migraine headaches may take 15 minutes or up to an hour.

Botox Treatment for Migraines

Recent research has shown that Botox injections may be an effective way to manage migraine headaches in select patients. Evidence suggests that the drug may interrupt the pathways of pain transmission between the brain and the nerves in the face, head and neck.

It can take several weeks after treatment to see a reduction in the frequency of your migraines and more than one set of injections may be needed.

The use of Botox to treat migraine headaches is approved by the FDA but it is important to talk to your doctor about all the treatment options available before making a decision. Botox treatment is only approved for people 18 and older who experience 15 or more migraine days per month.