Q: How are migraine surgery patients selected?
The first step in the selection process is that you must first download, complete and return the new patient questionnaire; this helps us to identify if you may be a candidate for treatment for migraine headaches. Patients must first be seen by a neurologist and must have a diagnosis of chronic migraine disease. The initial consultation with Dr. Delaney is to determine whether the patient is a potential candidate for Botox® treatment, and/or surgical treatment. Currently, there are four known trigger sites for migraine headaches: eyebrow, temple, back of neck, and nasal passages. Each of these sites, with the exception of the nasal passages, can be evaluated by use of Botox® injections. The nasal passages can be tested with nasal sprays, as well as with physical and x-ray findings.
Q: How long is the selection process?
Following the initial consultation visit, variables such as frequency, severity, location and duration of migraine headaches are tracked and logged by the patient. With this information, Dr. Delaney may begin with a series of injections of Botox® in specific trigger sites. The patient tracks the results during the month following each injection, helping to identify the effectiveness of the Botox® in the various trigger sites. This information may help Dr. Delaney determine whether or not the patient is an appropriate candidate for surgery. Those patients who observe a significant reduction in frequency and severity of migraine headaches with the use of Botox® are considered excellent candidates for surgery. The surgery does on a permanent basis what the Botox® does on a temporary basis. Those patients who have not responded to Botox® treatment may also be candidates for surgery depending on personal medical history.
Q: How does Botox® affect migraine headaches?
Botox® results in the temporary weakening/relaxation of the muscles that impinge on the nerves which have been pinpointed as trigger points for migraine headaches.
Q: How do I know if I am a candidate for migraine surgical treatment?
Migraine surgery candidacy is determined on multiple factors, including migraine history, response to treatment and overall medical condition.
Q: What is recovery like?
Migraine surgery is typically done on an outpatient basis, with patients going home following the procedure. Generally, patients are out of work for one to two weeks until swelling and bruising is resolved. During this time, patients shouldn’t plan to exercise or engage in strenuous activities, such as heavy lifting. Some headaches and discomfort should be expected during this time, and is treated with appropriate pain medication.
Q: Are there scars?
Yes, however, all scars are typically hidden in the hair or at the hairline. Nasal airway incisions are inside the nose and will not be visible.
Q: When do I notice results?
Improvements usually begin approximately two to four weeks after surgery.
Q: Can Botox® be used as a treatment?
The answer varies. For a patient who experiences frontal headaches only, injection treatment may last for 6-12 weeks. The majority of patients also have temple or neck issues. Long term injections in the temple region will result in hollowing of the temples, otherwise known as “hourglass deformity.” Long term injections in the neck are not likely to cause a problem, but may last just 6 weeks. Nasal airway triggers can often be helped with decongestants, but otherwise must be treated surgically.
Q: Can anyone inject Botox®?
One should consider that the most effective, longest-lasting Botox® injections are those injected into the anatomically correct location. Injections into areas which have failed to respond to previous Botox® injections may be successful if the injecting surgeon works within and is familiar with the anatomy in three dimensions.
Q: Will my insurance cover Botox® injections or the surgical procedure?
At MUSC Health, we have been successful in obtaining insurance authorization for Botox treatment and migraine surgery in many cases. In the event that your insurance will not cover your migraine surgery, our team at MUSC Health has made arrangements to make it possible to receive treatment at a discounted rate.
Q: How many sites usually need surgery?
Most often, two or three sites need to be addressed during migraine surgery. Less commonly, single site or four site patients are encountered.
Q: What are the benefits of surgery versus medications?
The use of medications for migraine headache relief has helped migraine sufferers to a certain degree, but many find that the medications are inadequate. The patient generally has to endure symptoms until the medications take effect, as well as experiencing a vast array of side effects often associated with the medications. The discovery that surgery has the ability to greatly decrease or eliminate migraine headaches has given hope to those who suffer from this debilitating disorder. For migraine patients, surgical treatment can be viewed as a shift from long term dependence on multiple drugs to a complete disruption of the migraine circuitry, ending the migraine cycle and all the lifestyle disruption that it causes.