When Should I Consider Having Botulinum Toxin or Surgery to Treat My Migraines and Headaches?

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Research has shown that migraine symptoms can be triggered by compression of peripheral nerves in the head and neck in susceptible patients.
This compression can be caused by a facial or neck muscles, bone, ligament or artery. In most cases, your surgeon can tell you what is the most likely cause of nerve compression based on the anatomic location of the trigger and quality of the associated headache and symptoms.

What is migraine and headache surgery?

The goal of the procedure is to decompress the trapped nerve(s) that are responsible for the symptoms from the surrounding structures (muscle, bone, ligament or artery).

How can we tell if I am a candidate for migraine and headache surgery?

  • Nerve block remains the gold standard to identify candidates for the intervention: Your surgeon injects a small amount of local anesthesia in the trigger site while you are having symptoms. If you experience improvement, then most likely the surgery will help you.
  • If you can point out with your finger the site where your headache starts.

How can botulinum toxin help?

Botulinum toxin relaxes muscles. If your symptoms are caused by a muscle compressing the nerve, then most likely you feel improvement. However, if the nerve is compressed by an artery, bone or ligament, it is unlikely to have improvement.

Is botulinum toxin treatment permanent?

It is not, and should be repeated almost every 3 months.

Is migraine and headache surgery a permanent solution?

Studies have shown that the vast majority of patients who get surgery will have long term relief, improvement or elimination of the symptoms associated with the treated trigger.

Who can perform migraine and headache surgery?


About the author
Dr. Ahmad Saad

Dr. Ahmad Saad

Medical Director – IMAGN Institute, Barcelona

Diplomate, American Board of Plastic Surgery
Asst. Prof. of Plastic Surgery – University of California, San Diego

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