Migraine surgery: learn how it works and when the procedure is indicated

Characterized by a strong and disabling headache, migraine is a neurological and hereditary disease that severely affects the quality of life. Crises can last up to 72 hours and appear for more than 15 days a month, accompanied by symptoms such as nausea, vomiting and sensitivity to lights, sounds and smells.

Crises are usually controlled from the administering analgesic medications. If they are not efficient, the specialist responsible for the treatment can prescribe the use of triptansdrugs based on tryptamine that have a low incidence of side effects.

According to Leonardo de Sousa Bernardes, a neurologist specializing in Neuro-Oncology at Hospital Albert Sabin, treatment can also involve non-pharmacological methods, such as physical activity, acupuncture, biofeedback and yoga.

However, in recent years, the implementation of migraine surgery has gained more and more space in Brazil and in the world — especially for people who do not show improvement in the face of conventional approaches.

Created in the early 2000s by the American plastic surgeon Bahman Guyuron, the method was developed from the perception that cosmetic surgeries in the frontal and upper face region ended up having the effect of reducing migraine symptoms.

How does migraine surgery work?

In a previous interview with MinhaVida, neurologist André Felício explained that painful stimuli enter the brain through peripheral nerves that start from the skin, vessels and membranes of the head and even the neck.

The peripheral branches of these nerves can be compressed by surrounding structures, such as muscles and bones, which causes the release of substances that trigger various events responsible for inflammation of nerves and membranes around the brain. This causes the main migraine symptoms such as severe pain, nausea and photophobia.

In this sense, the procedure consists of decompressing two types of nerves associated with sensitivity: the triplet (it is the main nerve of the face and passes through the nose, cheeks, forehead, lateral and maxillary regions) and the occipital (which passes through the nape and back of the head).

It is important to point out that this is a superficial surgery and therefore does not reach the brain. Currently, there are seven types of migraine surgery, each for an area where the pain usually starts. The origin of the pain is what determines where the procedure will be done.

Who is migraine surgery indicated for?

Migraine surgery can be performed on any patient who has been diagnosed by a neurologist and who did not respond to conventional treatments. The method also addresses people who suffer from the side effects of medications or have intolerance to them.

In the United States, where the surgery is most popular, it is performed at universities such as Harvard. In Brazil, the procedure is considered experimental by the Brazilian Academy of Neurology and by the Brazilian Headache Society. Therefore, neurologists cannot perform it. However, it is important to highlight that the Federal Council of Medicine (CFM) does not prevent the practice.

The price of the surgery can vary between BRL 5,000 and BRL 50,000, depending on the complexity of the intervention. It is done in hospitals and most often requires general anesthesia – it can last from 20 minutes to five hours. Hospitalization lasts only one day and the patient can return to their activities between ten and 15 days after the procedure.

As with any procedure, there is a risk of bleeding and infection, besides one temporary change in sensitivity of the affected region.

Are there other procedures to treat migraines?

Migraine treatments are varied and can range from use of painkillers up until non-pharmacological methods. The indication may vary according to the type of migraine and, in general, it aims to reduce the frequency and intensity of pain throughout the month.

Read more: Migraine: what to do during a crisis?

In addition to the already known treatments, another approach includes the application of botulinum toxin for migraine, option authorized by ANVISA since 2011 and which seeks to reverse the situation, minimizing the occurrence of crises.

The technique includes the application of the toxin in several areas of the head and cervical region, which acts as a neuromuscular blocker. By causing the blockade of the transmission of stimuli from neurons to muscles, it prevents muscle contractionwhich makes the region more relaxed and contributes to migraine relief.

Contraindications for the procedure exist for people allergic to botulinum toxin, pregnant women and people with diseases in the muscle joints. Patients diagnosed with active infections should also avoid treatment.