Migraine Operation

The ‘Discovery’ of the Migraine Procedure

The Migraine Procedure was discovered by chance in the USA in the year 2000.  In a clinical study involving 314 patients, surgeons removed the corrugator muscle, a small muscle around the eyebrow, in order to eliminate ‘frown lines’.  Prior to the procedure, 39 of the 314 patients had experienced migraine. One year after surgery, 31 of these 39 patients reported that their migraine had either disappeared completely or diminished considerably.

The corrugator muscle forms ‘frown lines’

Corrugator-Muscle

These findings prompted surgeons at the University Hospital in Cleveland (USA) to look more closely at the link between the corrugator muscle and migraine. Since then, a number of studies have been published on the efficacy of operative migraine therapy, including a study in the New England Journal of Medicine. In addition, patient data from the USA, Austria and Germany has demonstrated that:

  • 35 per cent of patients experienced complete relief from migraine symptoms one year after the surgery.
  • In a further 57 per cent of patients, the frequency of the attacks and the intensity of the pain were reduced by more than half following the procedure.

The surgical approach to migraine therapy

Surgical migraine therapy involves relieving pressure on various branches of the trigeminal nerve. In many people it is the interaction of the corrugator muscle and the trigeminal nerve that leads to a migraine attack. The corrugator is positioned above the eyebrows and is one of the muscles responsible for forming ‘frown lines’ or other expressions in that part of the face.  Part of the trigeminal nerve passes through the corrugator muscle: as a consequence of irritation of the nerve, a cascade of events is initiated which can lead to a migraine attack.

The surgeon makes a small incision along the eyelid crease in order to remove the pain triggering muscle – in most cases the corrugator muscle. The nerve in the muscle is neither removed nor damaged in the procedure. By removing the muscle, the nerve in the trigger area above the eyebrow cannot be stimulated and therefore migraine symptoms are eliminated.

Trigger areas on the temples can be treated surgically by the same principle. Pressure is relieved on the corresponding nerve through keyhole surgery, with the surgeon accessing the nerve via the section of the temple that is covered by hair. The third possibility is to relieve pressure on a nerve located in the neck.

It is vitally important that each case is examined individually and that each patient undergoes a botulinum toxin (Botox) test before they are considered for the procedure. If migraine symptoms improve by more than 50 per cent in the first eight weeks after the injection of botulinum toxin, this is a positive, prognostic indicator for the success of the Migraine Procedure. 

In addition to relief from migraine symptoms, the patient will notice that the ‘frown lines’ between the eyebrows soften, and in most cases, disappear.