Surgical Therapy of Migraine and Tension-Type Headache

Abstract

During the last few years, multiple studies have demonstrated the efficacy of migraine and tension-type headache trigger site deactivation surgery, hence expanding the therapeutic potentiality of plastic surgery. These procedures are performed based on headache onset and location: four trigger points that may cause the compression of the trigeminal branches have been described. In the present chapter, we describe indications, contraindications, procedures, and results of this therapy, focusing on our approach that relies on one 1-cm incision, and it is performed under local anesthesia.

Minimally Invasive Surgical Treatment of Migraine

“…In the following years, independent researchers demonstrated the efficacy of botulin toxin injection for the treatment of MH [2]. These evidences supported the hypothesis that MH was determined by the peripheral activation of trigeminal nerve branches.…”

“…Migraine headache (MH) is known to affect over 324.1 million people worldwide [1,2]. However, MH is still widely undiagnosed and undertreated.…”

“…However, MH is still widely undiagnosed and undertreated. In US alone, MH treatment cost accounts for over $17 billion each year, without taking into consideration the indirect costs due to the 112 million annual workdays loss, which has an estimated cost of $14 billion [2][3][4]. Furthermore, MH has an even greater burden on patients' everyday life, their families, and the society.…”

“…Among the numerous hypotheses proposed over the years regarding MH etiology, none has come to clearly highlight its true nature. Some researchers have proposed that MH might be originated from a central neurovascular phenomenon, others have hypnotized a cortical neuronal hyperexcitability, others a cortical spreading depression, others an abnormal modulation of brain nociceptive system, and eventually others have demonstrated a central/peripheral activation with sensitization of the trigeminal system [2,5]. But still MH pathophysiology is unclear and a matter of international debate.…”

“…Plastic surgeons were never looking for a surgical treatment for MH; however, this idea came into their eyes in 1999 following the reports made by patients that underwent corrugator supercilii muscle resection for forehead rejuvenation surgery and experienced elimination or improvement in their MH after [2,5]. In 2000, Guyuron et al [5] first reported in a retrospective study this association between corrugator supercilii muscle resection and disappearance or significant improvement in MH attacks, paving the way for a new MH origin and thus a new treatment option.…”