Am I A Good Candidate For Migraine Surgery?

Q: Dr. Eppley, would the following make me a favorable candidate for migraine surgery? I have a history of chronic migraines for over 15 years. It is well controlled for the past 5 years with Botox injections in four areas (forehead, above ears, back of head, and around eyes) and manual therapy. I have noted a reduction in the effectiveness of Botox injections in the last 18 months.

A: On the surface, a positive response to Botox suggests that migraine surgery can be effective. However it is important to know exactly where the Botox was injected and whether those sites corroborate with the exact anatomic sites of peripheral nerve compression. Where in the forehead and the back of the head exactly? The above the ear and around the eyes are not sites where nerve compression can occur so these may be completely incidental to whatever improvement you may have been seeing to the forehead and back of the head injection sites. (if in fact they were near the course of the nerves) These injections sites sound suspiciously like a very typical ‘wrap around’ the head injection pattern that I have seen done many times by neurologists. Such a random approach is not necessarily indicative that migraine surgery would be effective.

Dr. Barry Eppley

Indianapolis, Indiana