SIU Healthcare Migraine Surgery Clinic
Welcome to the SIU Healthcare Migraine Surgery Clinic within the Institute for Plastic Surgery. For anyone who has suffered from chronic migraine headaches or who has watched a loved one suffer, you know how painful, debilitating and disruptive they can be. We are very pleased to be able to offer a proven successful surgical option for the treatment of chronic migraine headaches for patients who have had inadequate response to medications intended to prevent or stop migraines.
Initial Phone Consultation & Evaluation
Prospective patients are contacted by phone by our Patient Coordinator. She will conduct an initial 20-minute pre-screening consultation to determine if you meet the criteria for further evaluation for migraine surgery.
- A history of chronic migraine headaches treated by a physician for a period of at least one year.
- Lack of response or inadequate response to standard medical and pharmacological treatment for migraine headaches.
- Patients must have been seen by a neurologist and have documentation of the diagnosis of migraine headache.
- Patients must have more than two severe migraine headaches a month.
- Absence of medical or neurological conditions likely to be the source of headache.
- Absence of unacceptable surgical risk including women who are pregnant or nursing.
If you meet the criteria our patient coordinator will:
- Mail you a patient package with all necessary forms included in the packet, along with instructions for completing and returning the forms
- Schedule you for an initial office visit 5-6 weeks after this phone pre-screening consultation
Note: Your first appointment will be scheduled 5 to 6 weeks out because you will be required to complete a 4-week consecutive tracking diary of your migraines before your initial office visit. This allows time for mailing your patient package and for completing and submitting your 4-week diary prior to being evaluated by Dr. Sommer.
Your medical history and Migraine Headache Diary will be reviewed by the patient coordinator and Dr. Sommer.
Dr. Sommer will conduct a focused physical exam and, if you are determined to be a candidate for migraine surgery, you will be given Botox® injections by Dr. Sommer in the migraine trigger zone(s) identified if insurance authorization has been given.
You will then be scheduled for a follow-up appointment in 12 weeks. Please note that it takes about one week for the Botox® to be effective. During this time, you will be asked again to record your migraines in your migraine headache diary for a period of 8 weeks beginning one week following the Botox® injections.
Post-Botox® Injection Visit
This is the most important visit in deciding whether or not a patient qualifies for surgery. During this visit the post-Botox diary will be reviewed and compared to your initial pre- Botox diary. There are 3 possible results from the Botox® injection:
- The migraine headaches were eliminated or improved by at least 50%. If this is the case you will be considered to be a candidate for migraine surgery. Dr. Sommer will then discuss the specific procedure(s) to be performed. If you decide to have the recommended surgery, then our office will work with you to schedule it.
- The migraine headaches improved but there are continued headaches in other zones. If this occurs, Botox® injections in the other zone(s) are administered and you will be asked to keep a new diary and will be scheduled for another appointment in 12 weeks.
- There was no improvement in the migraine headaches at all. In this case, surgery is unlikely to help. Dr. Sommer will return your care back to your Primary Care Provider.
Migraine Surgery Treatment
Migraine surgery is performed under general anesthesia and is typically done on an out-patient basis. On the average, surgery takes approximately 1.5 hours per zone that is surgically treated.
- Frontal Migraine Surgery involves surgical removal of the corrugator muscles. Frontal migraine surgery is performed through small incisions above the upper eyelids. Both sides will be treated even if the majority of symptoms occur on one side in order to prevent facial asymmetry. Most patients will notice some numbness of the forehead after surgery, but this typically resolves within a few months. Most patients will also get significant bruising around the eyes which may last for 1 – 2 weeks.
- Temporal Migraine Surgery involves resection of the zygomaticotemporal branch of the trigeminal nerve (ZTBTN) nerve. This is a very small nerve and provides sensation to a very small area so this surgery does not result in any noticeable numbness. The small incision is hidden in the temporal hairline. Patients may experience loss of some hairs around the hidden incision.
- Occipital Migraine Surgery involves release of the greater occipital nerve (GON) from the compressing structures in the back of the head, where the base of the head and neck meet.
- Nasal Migraine Surgery (also known as rhinogenic migraine surgery) is indicated when enlarged turbinates are in contact with the nasal septum and is addressed with a septoplasty and turbinate reduction.
What We Need from You
Follow instructions for completing all required forms as indicated in the patient package that will be mailed to you. In order to give all our patients the best care possible all forms must be filled out and returned prior to your visit.
The 4-week diary of your migraine headaches is extremely important information for Dr. Sommer to review and analyze so that your migraine trigger zone can be accurately identified. This information becomes the basis of the treatment plan that Dr. Sommer will recommend for you and needs to be returned as instructed prior to your appointment with Dr. Sommer for planning purposes.
Migraine Trigger Zones
Migraine headaches may be triggered by irritation of nerve endings in well delineated areas of the head and neck. The irritation of these nerve endings may eventually lead to a migraine attack. These nerve endings are located in 4 defined zones. Botox® injections can be used to identify 3 of the zones; specifically the frontal, temporal and occipital migraine zones. Positive Botox® responders are considered to be candidates for migraine surgery. It is important to note that some patients suffer from migraines involving more than one zone. Dr. Sommer will determine which zone(s) are appropriate to address with migraine surgery. For the frontal, temporal and occipital zones, surgical candidates are those who respond positively to Botox® injections of the specific zones.
Defining Characteristics--4 Common Migraine Trigger Sites:
1. Frontal Zone Migraines
- Pain located behind the eyebrows, between the eyes or on one or both sides of the forehead (frontal pain)
- Stress related
- Frontal migraines result from pinching and irritation of the supra-orbital nerve (SON) and the supratrochlear nerve (STN) by the glabellar forehead muscles (the corrugator muscles also known as the frown muscle).
- To help determine frontal zone migraines, Dr. Sommer will inject Botox® into the area of the corrugator muscles. If a patient with frontal zone migraine headaches responds to Botox® injections with a 50% or more reduction in the frequency, severity and duration of migraines then the patient is a candidate for frontal migraine surgery.
- Frontal zone migraine surgery entails surgical removal of the corrugator muscle and release of the nerve(s) which can result in elimination of the migraines or significant reduction.
2. Temporal Zone Migraines
- Pain located in the temple area and the side of the head
- May be triggered by stress
- Temporal zone migraines are triggered by the contraction of the temporalis muscle (large muscle used in chewing) causing irritation to the zygomatico-temporal branch of the trigeminal nerve (ZTBTN).
- To determine if the temporal zone area is responsible for a patient's migraines, Dr. Sommer will inject Botox® in the area of the ZTBTN. If this results in 50% or more reduction in the frequency, severity and duration of migraines, then the patient is a candidate for temporal zone migraine surgery.
3. Occipital Zone Migraines
- Pain located in the back of the head and upper neck
- Occipital zone migraines are caused by the semispinalis capitis muscle and the greater occipital vessels compressing and irritating the greater occipital nerve (GON).
- To determine if the occipital zone area is a trigger point responsible for a patient's migraines, Dr. Sommer will inject Botox® in the area of the GON. If this results in 50% or more reduction in the frequency, severity and duration of migraines, then the patients is a candidate for occipital zone migraine surgery.
4. Nasal Zone (also called Rhinogenic) Migraines
- Caused by septonasal triggers where intranasal structures compress the trigeminal end branches causing paranasal (around the nose) and retrobulbar (behind the eyes) migraine headaches.
- Botox® cannot be used to diagnose this area as a trigger point.
- For patients with obvious deviated nasal septum and migraine location typical for nasal zone migraines, a nasal exam will be performed to detect nasal deviation and or turbinate hypertrophy (enlarged turbinate).
- A CT scan will be ordered to help document nasal pathology as the reason for the migraine. CT scans confirm septal deviation, enlaged turbinates or other abnormalities including bony spurs.
Migraine surgery has been demonstrated to provide a complete cure in 35% of patients who respond to Botox®. However, more than 90% of properly selected "Botox® Responders" dramatically improve after migraine surgery with reported decrease in frequency, severity and duration of the migraines. Migraine surgery takes the pressure off the irritated nerves, making the patient more resistant to triggering factors which raises the threshold for developing a migraine attack.