Q: Dr. Eppley, I have a teenage daughter with nonstop migraine headaches for over a year and I suspect occipital neuralgia. I’d like to know more about what you do for migraines. Thank you.
A: There are some specific non-surgical and surgical treatments for migraines that have identifiable trigger points. Most so-called migraines do not have trigger point, however, Trigger points can be identified by both history and physical examination. Almost all of the patients that I treat for migraines as a plastic surgeon have been through full medical work-ups usually by a neurologist and have failed all conventional medical therapies.
Trigger points are specific areas where sensory cranial nerve branches pass through muscles on their way to supply specific skins areas. The muscles squeeze or pinch the nerves which serves as the trigger point for the migraine. The three most common trigger point areas are the occipital, temporal, and frontal regions. Sometimes only one trigger point exists but it can include two or even three. By far, the occipital trigger point is the most common in my migraine patient experience.
The initial treatment of a suspected ‘trigger point’ migraine is Botox injections. This is both a treatment as well as a diagnostic test. If sufficient relief is obtained, then one can continue with Botox injections or proceed with nerve decompression surgery where the constricting muscle is removed around the nerve.
This is a general migraine treatment overview. The use of Botox and decompressive surgery are rare in adolescents for migraines but, in the properly qualified patient, would be acceptable.
Dr. Barry Eppley