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Мигрень

Migraine surgery

When medications, diets and alternative medicine do not help.

  • Safety
  • Efficiency
  • Validity

Sky Clinic of Plastic and Reconstructive Surgery by Aleksey Dikarev is the first clinic in Russia that offers surgical migraine treatment based upon systemic approach, with proven efficacy and careful selection of patients.

What is migraine?

Migraine is a recurrent headache in combination with several other neurological symptoms: nausea, hypersensitivity to light and sound, impairment of speech, mood swings, inability to focus, and increased tone in neck muscles. There are individual variations in the set of symptoms, intensity and duration of the headaches, as well as regularity of migraine attacks. In some cases, the migraine can last for several days and become an incapacitating condition.

The underlying causes of development and progression of migraine are still unknown. We can just state the facts:

  1. One in 10 persons on Earth, including children, suffers from migraine.
  2. 70% patients with migraine are women
  3. In two thirds of all registered cases of migraines, the patients have a family history. This disease is considered to be genetic.
  4. About half of persons who suffer from migraine do not carry “official” diagnosis.
  5. 2% people suffer from chronic migraines that recur for more than 15 days a month.
  6. Pharmacological therapy for migraines is effective only in a half of all the cases.
Иллюстрация из книги "Migraine Art"

Methods of migraine treatment

Pharmacological treatment is represented with a large range of medicines. The class of Triptanes is considered the golden standard..

As it was mentioned above, medications do not help for migraine attacks in half of all the cases. Moreover, effective medications cause addiction resulting in recurrence of the pains after they are discontinued.

Some patients takes several types of medications to suppress migraine attacks, or exceed the maximum tolerable dose. It can lead to overdose and related health problems.

Семейство триптанов для лечения мигрени

Nerve stimulation by weak electric current.

There are two main types of devices for neurostimulation:

  1. Devices that require their surgical implantation into the skin;
  2. Non-invasive devices that work through the skin.

The efficacy of neurostimulation is comparable to the efficacy of pharmacological therapies. It helps in about half of the cases. Besides, nerve stimulation is only an addition to pharmacological treatment, not substituting it completely.

Today, this area is under intense study, and we follow up the results of the research carefully.

The recent excitement about neurostimulation for treatment of headaches attracted many quacksalvers to the market, who sell devices that simply do not work, at best.

Nerve block is an injection of anaesthetic and steroid medications to “turn off” branches of the trigeminal nerve. The block starts after several minutes and lasts for several days or even several months. Yelena Malysheva stated that pharmacological nerve block of occipital nerve cured her of her migraines for 5 years.

The block is used as a test to predict potential success of surgical migraine treatment.

The block acts on the nerves responsible for sensitivity.

Блокада затылочного нерва для лечения головной боли

Botox injections “turn off” the muscles in the area of the administration. If the headache is caused by a nerve that is pinched between the muscles, then this migraine goes away and does not recur while botulism toxin works for 10 to 12 weeks.

Botox demonstrated efficacy only in the chronic migraine treatment. The chronic migraine is a headache that occurs more than 15 days a month.

The injections of botulism toxin are used as a test to predict potential success of surgical migraine treatment.

Botox acts on motor nerves.

Ботокс для лечения мигрени (головной боли)

Surgical migraine treatment is a modern and the most promising treatment that targets the causes of the headache, not just consequences.

The surgery is focused on nerve decompression, that is, freeing a nerve that is pressed with muscles and bone structures.

This method is described in the next section.

Хирургическое лечение мигрени

Surgical migraine treatment

The research in the area of surgical treatments for headaches started in 2000. In 2018, the results of retrospective studies were published that proved the efficacy of surgical treatment in not less than 80 % (if the selection of patients was appropriate).

The effective treatment includes either complete control of migraine or the reduction of its intensity and duration at least by half.

The research demonstrated the following:

  • Migraines can be caused by a pinched branch of trigeminal nerve.
  • Nerves get pinched between muscles or bone structures
  • The decompression of pinched nerve results in significant improvement of migraine course or to its complete disappearance.
  • Incomplete resolution of migraine is an evidence of the presence of other pinched nerves that were not found before the surgery.
  • Positive sensory nerve block test or positive botox injection test indicate that there is a pinched nerve in the area of injection.

The area in which nerve compression happens is called a trigger zone. Known trigger zones are shown in the picture below.

Триггерные зоны мигрени
Trigger zones for migraine ©Bahman Guyuron

It is not always possible to identify the trigger zone. Some patients has several trigger zones. These are two reasons that necessitate another surgery if the migraines do not disappear completely after the first surgery.

The trigger zone can be identified the most precisely during a migraine attack.

In the majority of cases, the identification of trigger zones is based on the following algorithm:

  1. If a migraine starts from the pain behind the eye, it is necessary to perform CTI of nasal sinuses. If certain markers are found on the images, then surgical treatment of migraine is indicated.
  2. If a migraine starts from the pain in another area:
    1. If the area can be identified by the patient, then instrumental investigation of this area is carried out and the relevant nerve is blocked with anaesthetics. If there the nerve block has a positive effect, then the surgical treatment is recommended.
    2. If the zone cannot be identified by the patient with certainty, then, depending on the presence of migraine during the patient’s examination, a nerve block or botox test can be performed. If the test results are positive, the surgical treatment is indicated.

Possible complications after the surgical migraine treatment

The surgical migraine treatment is focused on identifying and decompressing the pinched nerve. This sounds frightening for many patients because of prejudices and assumptions of non-professional mass media around possible nerve damage during the surgery. Such arguments do not stand up to scrutiny because of two reasons.

An injured nerve can be restored.

Nerve restoration is a difficult task that many plastic surgeons are not able to manage. To connect a nerve, microsurgical skills are required, as well as a special microscope in the operating room. Our surgeons perform reconstructive microsurgical surgery on a daily basis and possess all necessary skills. Of course, we have the microscope that enables us to put together nerves and vessels that are smaller than a human hair in diameter.

In surgical migraine treatment, the surgeon works with nerves that are responsible for sensitivity. There are two types of nerves:

  1. Sensory
  2. Motor

An injury of a sensory nerve results in a loss of sensitivity, while an injury to a motor nerve results in a loss of mimic movements. Both types of injuries can be restored during the surgery. The innervation does not return not immediately that is why sensitivity and mimic movements come back gradually. While a lack of mimic movements is an aesthetic defect that other people can notice, the absence of sensitivity goes unnoticed by other people. In addition, sensitivity can return spontaneously in some cases, thanks to collateral innervation by other branches of trigeminal nerve.

Migraine treatment price list

Nerve block

Injection of local anaesthetic to suppress headache

0 rub
Injection of botulism toxin

Treatment of headaches with botox

37 000 rub
Nerve decompression in the periorbital zone

Area of forehead and eyebrows

89 000 rub
Decorative elementDecorative element
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