Can Secondary Triggers For Migraines Be Treated Successfully After Primary Migraine Surgery?

Q: Dr. Eppley, I have been very pleased with the surgery you performed on me this past May. By the end of 2011, I started have chronic migraines (pulsing in temples). It was really debilitating and interfered with my work, going out with my friends and husband, and everyday activities like working out. After the surgery, I am no longer in constant pain and I feel like I am getting my life back! I still have some minor pulsing in my temples. I am working with a local Neurologist to try to alleviate the pulsing. But even if we never resolve the pulsing, I feel like I will be able to live a normal life. Since the surgery, I have started having some pain in my forehead (right between my eyebrows and right above the eyebrows). It not nearly as extreme or painful as what I had experienced in the temples. It does not occur every day. The Neurologist has prescribed a low dose of Baclofen to take when I feel the forehead tension and that works well. But I was curious whether it would not just be better treated surgically? I had read that patients sometimes develop secondary trigger spots after having the primary trigger spot operated on. I was wondering if you thought that it might worth having a second operation done. What exactly would the procedure be, are the muscles removed?

A:  It is well known that the successful treatment of one trigger point for migraines can potentially unmask or uncover another more minor but contributing source. For the temporal-based migraines, the unmasked trigger point is the suprarobital-supratrochlear region located in the  inner brow area. Unlike the temporal region, this migraine trigger site is treated differently. It is approached using an endoscopic technique from two small incisions behind the frontal hairline. Through the endoscope, the muscles are removed from around the nerves as much as possible and, in some cases, the bony foramen where the nerves emerge from the brow bone are opened up to decompress the nerve completely. This takes the same amount of time to complete, around one hour, as the temporal migraine surgery.

Dr. Barry Eppley

Indianapolis, Indiana