Migraine FAQ

Migraines have four stages. They are:

• Prodrome Stage: Often involves irritability, depression, sleepiness and problems concentrating.
• Aura Stage: Includes visual disturbances, temporary loss of sight, tingling or numbness in parts of the body, and tinnitus.
• Attack Stage: Often characterized by throbbing headache pains that usually involve one side of the head.
• Postdrome Stage: Involves feeling foggy with an inability to concentrate and tiredness.

While these four distinct stages have been identified, not all migraine patients experience all four stages.

Headache is only one aspect of a migraine. Migraines often have other associated symptoms such as nausea, photophobia, sound sensitivity and tiredness.

Chronic migraines are migraines that occur often and over long periods of time. Chronic migraine sufferers often seek many different types of treatments to find relief from their headache and migraine symptoms, as they may be debilitated by the condition’s long-standing effects.

Migraines are usually diagnosed by a physician. The classic diagnosis of migraine involves the four stages of a migraine: prodrome, aura, headache and postdrome. However, since many migraines do not have all of these stages, an evaluation by a physician can help with diagnosis and can be based on headache severity, headache length and how often a patient gets their headaches.

Migraine surgery involves the release, or decompression, of peripheral nerves in the head and neck that are known triggers of migraine pain. Migraine surgery is an outpatient operation that usually takes one to three hours.

Migraine surgery is NOT brain surgery; it is performed on nerves that lie just below the skin or in the superficial muscles of the back of the neck. In many migraine patients, the irritation of these peripheral nerves causes the chronic migraine or tension headache pain. Our surgeon releases these nerves from compressing and irritating the surrounding tissues, which then stops the nerves from transmitting distressing signals to the brain and relieves the migraine pain.

Some migraine patients use over-the-counter medications such as Tylenol, Advil or Excedrin. Besides that, other medications such as beta-blockers for high blood pressure and antidepressants may be prescribed. Repeated or frequent use of migraine medication may result in rebound migraines, also known as Medication Overuse Headahces. You should discuss the use of any and all headache medication with your doctor.

Narcotics are dangerous medications that can cause rebound headaches and addiction. Chronic use of narcotics such as oxycodone “rewires” the pain centers of the brain, often causing pain syndromes that are ongoing, recurrent and very difficult to treat. We strongly urge patients to consider migraine surgery before taking any narcotic medications.

Patients with migraines should see their primary care doctors, who may prescribe several different migraine medications. Some migraine patients might be resistant to certain medications and are often referred to a neurologist for further checks. Migraines can be difficult to treat with medications alone. Candidates who opt for outpatient migraine surgery usually see an improvement in their pain over 90% of the time.

Patients first see their primary care doctor for their migraines. When a specialist is required, patients are often referred to a neurologist. However, most patients looking for a durable option that does not involve chronically taking medications should seek out the care of a migraine surgeon such as Dr. Lowenstein. Patients may also seek out a migraine surgeon if they are unhappy with the side effects of their medications, or have failed other treatments.

Most migraine and tension headache patients are good candidates for migraine surgery. Dr. Lowenstein will perform short-term nerve blocks on the nerves suspected of triggering your pain to evaluate if you’re a good candidate for migraine surgery. These nerve blocks often relieve the migraine headache for a short time, indicating that the nerve is the cause of the pain. Addressing this nerve surgically can often provide long-term migraine relief. Most migraine patients that we see at our Migraine Surgery Specialty Center are good candidates for the surgery and are responsive to these nerve blocks.

Recovery from migraine surgery varies from person to person. Many patients report that their pain is gone immediately following migraine surgery, while other patients may experience intermittent headaches in the weeks following the surgery. Postoperative pain from the incision and dissection is usually present for the first few days, but it isn’t a significant issue for recovery. Most patients are up and about the day following migraine surgery and can resume normal activities the following week.

Migraine surgery can take between one to three hours, depending on the number of nerves that require attention. Pre-operative nerve blocks by Dr. Lowenstein allow the doctor and patient to understand the location and number of the nerves involved, so patients are well aware of the expectations for their particular surgery.

Migraine surgery is most often performed in an outpatient surgery center. At the Migraine Surgery Specialty Center, Dr. Lowenstein has a specialized operating and private recovery room to provide optimal outpatient care for our patients. Our experienced team aims to make the operative experience as easy as possible for migraine headache patients.

Migraine surgery does not require an overnight stay in a hospital. Patients are seen the day after surgery and a few days following to answer any questions that might arise. In some cases, a visit a week following surgery may be needed to remove sutures. Dr. Lowenstein will continue to consult patients for months after each procedure, either in person or via phone or video call.

Brain surgery is much more complex than migraine surgery. Brain surgery is done in a hospital and involves accessing the brain through the skull. Because brain surgery is rather invasive, there are significant risks and side effects. Migraine surgery has minimal risks and side effects. Patients are allowed to go home the same day and almost immediately return to their normal activities.

Migraine surgery is performed through well-hidden incisions that heal with hardly noticeable scars.

Migraine surgery is highly effective in reducing or eliminating the pain and symptoms of migraine headaches. Over 90% of migraine surgery patients experience at least 50% improvement in their pain and migraine symptoms. About half of those patients experience complete relief from all of their migraine pain and symptoms.

You may want to consider migraine surgery if:

• You have tried many other means of controlling your migraines without success.
• You are unhappy with the side effects of the migraine medications that you are taking.
• You no longer want to deal with the ongoing expense of migraine medications and visits to doctors.
• You have been unable to find a medication that helps your migraine pain.
• You have been prescribed narcotics and do not want to risk narcotic dependency or medication over-use headaches.
• You have multiple migraines each month, and your migraine is debilitating your lifestyle.

Following a successful migraine surgery, the results should be long-lasting, and there should not be any need to repeat the surgery. In the rare instance that the surgery does not reduce symptoms, secondary revision surgery can be performed with different techniques to control particularly troublesome nerves. However, a second surgery is required less than 10% of the time.

Different insurance plans cover different types of procedures, so it may be necessary for you to contact your insurance carrier to determine the extent of your coverage.

Migraine surgery can be effective for many different types of headache pain, including tension headaches, chronic daily headaches, cluster headaches, post-traumatic headaches and even hemiplegic migraines.

Tension headaches are characterized by pain in the head and neck, often caused by tight muscles. Many people are known to “hold their tension” in the shoulders and neck and the muscles in that area, particularly the trapezius muscle, become tense and tight.

YES! Migraine surgery is also called nerve decompression surgery. In the case of tension headaches, this outpatient surgery releases the greater occipital nerve from the tight and tense muscles that are causing irritation. Migraine surgery decompresses the nerve from the surrounding tense muscles. This prevents the nerve from sending distress signals to the brain, so the tension headaches do not occur in the first place. Release of the nerves that are near these muscles often alleviates the associated headaches, and can break the cycle of headache pain-causing tension, and tension causing headache pain.