Q: I would like to schedule a consult with Dr. Eppley. I have migraines and have found that Botox was a big help to me making it at least 50-60% better. I also have neck pain badly. I think his decompression Surgery may be beneficial. I would like to speak to him about this.
A: The debilitating nature of many migraines begs for more effective solutions. In the past, the only approaches to the treatment of migraines has been pharmaceutical, obtaining some symptomatic relief. The most recent pharmaceutical treatment has been the use of Botox injections. For a very specific subset of migraine sufferers, Botox has been shown to be effective if the focus or trigger has been associated with the exit of sensory nerves from the skull base. This is usually the supraorbital/supratrochlear nerves in the brow area and the greater occipital nerve at the back of the head.
Botox works by relieving the spasms of the enveloping muscles as the nerve exits close to or at some distance from the bone. If Botox produces a profound response, this strongly indicates that surgical decompression (removal of muscle around the nerve) could be equally effective and offer better long-term results. In some cases, even a cure might be achieved. Plastic surgeons have long recognized this surgical approach coincidentally with endoscopic browlift procedures where muscle removal around the nerve is done to help decrease wrinkling after surgery and some cosmetic patients comment that their headaches are better.
If the origin of the migraine and Botox injection relief is from the back of the head (occipital area) then decompression of the greater occipital nerve and release of the fascial attachments frm the back of the skull may work quite well. This is done through two small incisions in the hairline where the neck muscle meets the bottom of the skull bone in the back of the head. It is a fairly simple procedure that is done as an outpatient. Migraine relief should be seen quite early after surgery. There is only very mild discomfort after the operation which passes ina week or so.
Dr. Barry Eppley