Q: Dr. Eppley, I am interested in migraine surgery. My migraine history is long. I started having migraines over twenty years ago. I take multiple prophylactic and rescue medications with mixed results. My headaches usually last two to three days and have lasted up to several weeks. The post-dromal lasts up to a week longer than that. I have had as little as a migraine every week or as many as a dozen migraines a month. I have been getting Botox for more than a year. Under normal circumstances I get a migraine a week, usually a 5-7/10 severity, taking the current medications. After the first day or two of rescue medications I stop taking them, I don’t think they do anything if they haven’t worked on the first day or so. I get Botox shots injections every three months.
A: Thank you for providing your detailed history and medication profile for your migraines. While migraines are complex, qualifying those patients that may have a successful outcome from migraine surgery is much simpler. The surgical treatment of migraines is based on identifying those migraine patients that have focal trigger points where the sensory nerves exit from the skull and pass through muscle where they can be entrapped. The three classic areas are the supraorbital, temporal, and greater occipital regions. Good surgical candidates have very specific trigger areas that they can pinpoint precisely, have repeatable symptoms from the same focal areas and usually have positive relief from Botox injections. Since you have had repeatable positive responses to Botox, it would be helpful to know more specifics about those injections. (location and dose)
Dr. Barry Eppley