**Surgical Management of Migraine Headaches Surgical Management of Migraine Headaches**

Michael Chung, Kyle Sanniec, Xingchen Li and Bardia Amirlak Michael Chung, Kyle Sanniec, Xingchen Li and Bardia Amirlak

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/66229

#### **Abstract**

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Although migraines are experienced by a significant portion of the population, current medical therapies often fail to completely alleviate the symptoms of many migraine sufferers, leading to significant residual disability. Within the last decade, migraine surgery has arisen as a viable option for patients who have exhausted all other medical treatments. Despite early resistance in the headache care community, it has become more accepted due to an increasing number of studies demonstrating efficacy and safety, and increasing evidence supporting the influence of peripheral nerves in the progression of migraine pathophysiology. Yet, it remains crucial to carefully select appropriate surgical candidates based on the assessment of various factors such as medication use, pain distribution, and any other medical conditions that may contribute to headache. It is equally important to ensure that the patient has a strong relationship with a neurologist for optimal medical management and postoperative medical support. After the appropriate trigger sites are identified, various techniques can be used to decompress the involved larger nerves, avulse the smaller nerves, and address any intranasal pathology that could be causing migraines.

**Keywords:** migraine surgery, chronic headache, nerve decompression, greater occipital nerve, lesser occipital nerve, occipital neuralgia, auriculotemporal nerve, zygomaticotemporal branch of the trigeminal nerve, supraorbital nerve, supratrochlear nerve

## **1. Introduction**

Migraine headaches (MH) affect over 37 million people in the United States [1]. One in four households will have at least one person experienced migraines, as the prevalence for females reaches as high as 18%, and males 6% [2]. Sufferers can develop severe disability that takes away their ability to do even the most routine daily activities. Many do not seek treatment, and even if

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

they do, traditional medications often fail to completely treat patients, leaving them with significant residual disability. It is estimated that one-third of migraine patients are refractory to preventative and pharmacological treatments [3]. A common and effective option for these patients is surgical decompression, which may be the only treatment that can provide permanent relief.
