Surgical treatment of headaches is an innovative use of peripheral nerve surgery.
What is it?
This specialty was started by Dr. Bahman Guyuron at Georgetown, who noticed that cosmetic surgery for the forehead sometimes resulted in headache relief. He began to study the nerves entering and exiting the skull.
Nerves exiting the skull have compression points – places where the nerve is in a confined space and can become irritated. Dr. Patel studied directly with Dr. Guyuron so that he could apply microsurgical techniques to help those with chronic headache pain, including relief of migraines and cluster headaches.
Am I a good candidate for headache surgery?
Dr. Patel works closely with his colleagues at the Headache and Neuralgia Center at Keck Medicine of USC to help with the diagnosis and management of headaches. Common treatments for headaches include nonsurgical options, such as Botox or steroid injections.
The ideal candidate for surgery is someone who:
- Feels some benefit from Botox or steroid injections, but still needs relief.
- Has tenderness at the point of a known nerve.
What can I expect from headache surgery?
Dr. Patel places incisions in hidden areas of the scalp.
- For frontal headaches at the forehead, the incisions are in the eyelid crease. Sometimes these incisions can be combined with eyelid rejuvenation therapy.
- For temporal headaches (at the sides) or occipital headaches (at the base of the skull near the neck), the incisions are well hidden within the hair.
Surgeries are outpatient procedures, and lasting from just one and a half to two hours.
What can I expect after headache surgery?
After surgery, patients usually feel some tightness. Patients are encouraged to maintain their full range of motion to relieve the tightness.
Most patients do have some pain after surgery, but it is usually not headache pain.
Some patients feel a temporary numbness in the area of surgery that goes away over time.
What results can I expect?
About 4 out of 5 patients who come to Dr. Patel through the Headache and Neuralgia Center for diagnosis end up with an improved quality of life. For some, that means fewer visits to the emergency room and less medication. For others, it means complete elimination of headaches.
A small segment of patients doesn’t experience much relief at all. Usually, this is because removing one type of headache (occipital, for example) unmasks another pain point, such as the forehead.
For anyone considering headache surgery, Dr. Patel recommends you start with a qualified neurologist.