Q: Dr. Eppley, I am interested in migraine surgery. I have had migraine headaches for years and receive Botox injections for relief. My neurologists injectes them all over my head every four months from which I get good relief. My question is knowing that I get Botox placed all over my head, does that mean I will need surgical decompression of all four nerve zones?
A: Nerve decompression surgery for migraines works by treating the known area(s) of nerve impingement. While Botox has been effective for you, its injection all over the head does not provide a clue as to whether any of the known three migraine nerve sites (supraorbital, zygomaticotemporal and occipital) would be effectively improved by the surgery. In migraine surgery you never just decompress every available nerve site as that may end up doing unnecessary surgery.
There may be some clue as to whether you have specific trigger zone involvement by a description of your migraine pattern. Does it start in one specific area? It is on one side or both sides? Can you put your finger on an area that is most tender or where it seems to come from? Such information would indicate which nerve site(s) should be decompressed.
Dr. Barry Eppley