Migraine relief: An exploration of options available to treat migraines and their symptoms

As knowledge expands and technology advances, we are beginning to bear witness to new innovations and emerging fields within plastic surgery. One area of new and promising innovation in plastic surgery is that of migraine relief.

You may not think of plastic surgeons when it comes to the treatment of migraines, but they actually play a major role in pioneering these groundbreaking procedures for patients who are suffering from debilitating migraines.

To gather more insight into this innovative space within the world of plastic surgery, we reached out to one of the leading experts in the field – Oren Tessler, MD.

ASPS: In considering the treatment of chronic migraines, plastic surgery has recently seen an increase in popularity as a safe and effective method of treatment. How has the field of migraine treatment evolved over your career in terms of patient expectations, popularity and techniques?

Dr. Tessler: I think the biggest change over the past several years has been increased awareness and acceptance. The initial novelty and suspicion surrounding the techniques have largely subsided, and the attitude of other specialties has become far more accepting and enthusiastic. Diagnostics have become more rapid and consistent. Anatomical understanding and standardization of techniques have helped the spread of the procedure.

ASPS: Who are the patients who typically come to you for migraine treatment procedures? Are there patients for whom these procedures would prove to be more beneficial than others?

Dr. Tessler: Most patients who come to me are long-term chronic migraine sufferers who have more than 10 migraines a month. Most have already had complete workups and have an active neurologist with whom they work. Almost all have attempted Botox to varying degrees of success. It is rare for me to have a patient that requires any investigation or confirmation of a migraine diagnosis.

ASPS: Are there any steps that patients need to take prior to pursuing surgical migraine treatment?

Dr. Tessler: I ask patients to come into the office when they are actively experiencing a severe migraine. Then I inject 1cc of Lidocaine 1% with epinephrine to the frontal, temporal and posterior potentially contributory peripheral nerves. I give them 10 minutes to lie down quietly in a dark room, and then we assess the effect on the active migraine. The results of this diagnostic inquiry are usually binary, with either near complete cessation of the active symptoms or little effect.

ASPS: What are the most popular current methods of performing this type of procedure? Have you seen anything being phased out?

Dr. Tessler: I usually use a simple blepharoplasty (eyelid surgery) approach to the frontotemporal nerves and can perform septoplasty (deviated septum correction) if required. For posterior nerves, I use a central 4cm midline incision and two 2.5cm lateral incisions.

ASPS: Are there any new methods or techniques upcoming in the near future that you would like to discuss?

Dr. Tessler: I believe there are always technical refinements that are being investigated that can be implemented into practice as they prove effective.

ASPS: Do you have any tips or advice for patients who are considering surgical intervention to treat migraines?

Dr. Tessler: The surgical procedure works in specific situations and patient populations that can be evaluated in the office. If the migraines are being well-controlled or are not causing significant disability, my advice is to continue with conservative management. If the patient qualifies, then they can expect significant improvement about 80 percent of the time. It is difficult to evaluate who will not experience significant relief.

Further, as the neuropraxia in some of the dissected larger nerves resolves, symptoms may increase slightly in the immediate postoperative period. I try to explain that even in peripheral neuropathies such as carpal tunnel syndrome if the nerve has been irritated or compressed for a long or severe enough period, recovery may be limited.

ASPS: Do you have any additional insights around this topic that you'd like to share?

Dr. Tessler: I believe this is a safe procedure that is worthwhile for patients who suffer from a disorder that is the ninth leading cause of disability in the world. For those who have failed conservative therapy and who respond well to diagnostic testing, it is a worthwhile procedure that can be life-altering. Although infrequent, there are some patients who have limited responses, and this can be emotionally difficult as their desperate hopes fail.

It is important to emotionally connect and guide patients through this potential and show understanding of their frustrations. Almost invariably, patients are extremely grateful that someone worked with them to try and help. These are people who have failed multiple previous modalities and are appreciative people. It is truly rewarding in this situation to be able to help people improve their lives.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.