**6. Complications**

Migraine surgery is regarded as a minimally invasive procedure; thus, no concerning side effects are usually reported.

All patients undergoing frontal decompression surgery with endoscopic approach will experience frontal and upper eyelid edema of various degrees. Usually the edema resolves by the fifth postoperative day. Ecchymosis of both upper and lower eyelids and zygotic regions also follows surgery and usually vanishes by the second postoperative week. No treatment needs to be given as these collateral events resolve by themselves; boric water applications three times a day may help the process of reabsorption of the edema. As previously stated, the only hypothetical serious complication that may occur within the 12 h following the surgery is the compression of the optical nerve due to the drop of the edema into the posterior orbicular space whenever the subgaleal dissection is carried out beyond the orbital rim. Prompt recognition of patient's sight modification is mandatory in order to urgently decompress the optic nerve. Decreased glabellar muscle activity till complete elimination may occur depending on the technique applied. Slight asymmetric eyebrow movement may be also noted [6]. Patients with particularly thin skin of the frontal region may develop postoperative burn-like scar (2%) as a consequence of the endoscopic electrocautery.

Any nerve avulsion may be associated with the formation of neuromas [5]. Nevertheless, avulsion of neither the zygomaticotemporal nor the auriculotemporal branches of the trigeminal nerve is reported to lead to the formation of neuromas [5, 8].

Temporarily anesthesia occurs in all patients, which lasts 163 days on average [5, 8, 12–15]. Other minor and transient complications reported are lasting occipital numbness at 1 year (5.7%), intense itching after surgery (5.7%), hypertrophic scar (2.7%), incisional cellulitis (1%) that resolve with oral antibiotics, transient mild incisional alopecia or hair thinning (5%), lasting neck stiffness at 1 year (9%), postoperative epistaxis (4.8%), early sinusitis in the recovery period following septum and turbinate surgery (4.8), and slight septal deviation recurrence (12.9%) [3, 5, 8, 9, 12–15]. Almost 54% of patients undergoing temporal surgery reported slight hollowing of the temple [5]. All patients that were refractory to surgery did not report worsening in their MH at any follow-up. Since the operation does not cause any serious complications or side effects, it can be recommended to patients with severe forms of migraine and symptoms of drug dependency. These patients still have a 50% chance of responding with partial or even total relief of their headaches.
