Will Additional Migraine Surgery Help?

Q:  I am writing because I have had migraine surgery for the occipital and temporal triggers last year. I am having a lot of migraines and tension headaches behind my eyes and above my eyebrows at this point.  The frequency is about three per week.  I can’t take it anymore. What do you see are my options at this point.  The good news is I haven’t had any migraines on the back of my head.  I am just discouraged because it seems the pain has migrated to another trigger site.

A: I think you do have some additional options at this point. The occipital area has had a good decompression which is why you have good results at this point. I always find occipital decompression works the best because it is the easiest and most direct to approach. The issue is the frontal/temporal region. There are two triggers in this area, one of which has not been treated at all (brow/supraorbital nerve) according to your description of your operation. It was not treated undoubtably because it was not a major contributor at the time. Treating one trigger can unmask other triggers. The temporal trigger (zygomaticotemporal) appears to have been treated from the temporal scalp approach which is not the best way. It has been learned that the main trunk of the nerve is in the midst of the temporal muscle and should be treated at this level which requires a different incisional approach. Both the supraorbital and the main trunk of the zygomaticotemporal nerve can be treated through an endoscopic browlift approach. Both nerves can be reached through two small scalp incisions and this additional migraine surgery should be helpful.

Dr. Barry Eppley

Indianapolis, Indiana