Migraine surgery is not a new procedure it has been since 1923 but initially, the results were not good as pathology was not clearly understood but in the year 2000 when forehead rejuvenation was done by a plastic surgeon and the patient reported disappearance of her migraine then research was conducted into the migraine surgery and in last 20 years we have come to the conclusion that migraine surgery is needed procedure for patients who are properly diagnosed cases.
The study says that there is complete absence of headache in more than 60% of patients and in rest 90% of patients there is a decrease of more than 70% in headache in the rest of the patients.
What is Migraine Surgery?
Migraine is a brain disorder with attacks consisting of headaches and other neurological symptoms. Nausea, vomiting, and/or sensitivity to light and noise often accompany headache, which is the most common presenting symptoms of migraines.
Migraine headache is the most common neurological disorder and one of the most common pain conditions and the eighth-most disabling disease in the world In childhood, it is slightly predominant in males, but after puberty, a 3:1 female predominance is seen.
Cause of Migraine Surgery?
Although it is not clear exactly what causes the headache. It is suggested it is genetic and there are two theories regarding the headache one is a central theory in which it is believed that headache starts from meninges and then proceed to external area and another theory believes that it is peripheral sensitization which is the main cause Although it is clear that central pathology is the main reason for this phenomenon, a peripheral mechanism with local release of inflammatory markers, which would activate trigeminal nociceptors, also probably plays an important role in this sensitization. The key to understanding the pathophysiology of migraine is the concept of peripheral and central sensitization of trigeminal nociceptive neurons.
Symptoms of Migraine Surgery?
Four Phases of Migraine Surgery
1. Prodromal phase- It starts 2 to 4 hrs before the headache and patients have irritation, yawning, inability to concentrate, stiff neck or anxiety
2. Aural phase- This is a classical symptom of migraine there is a blind spot in peripheral vision, shimmering of light, slurred speech, smell changes, double vision, altered hand movement, dizziness this phase last for 60 min.
3. Headache phase- There is throbbing pulsating pain and it can have point in frontal area, temporal area and occipital area and then spread to the whole head. Last for 4 to 72 hrs
4. Resolution phase- .patient is fatigued, irritable, decrease the concentration.
According to international classification of headache disorder 2013 patient should have these criteria to fulfil for migraine Surgery in delhi.
At least FIVE Headache attacks, each lasting 4 to 72 hours and fulfilling criteria A and B below:
A. Headache with at least TWO of the four characteristics:
3. Intensity: moderate to severe.
4. Aggravation: by routine physical activities.
B. During the headache, at least one of the following two features is present:
1. Nausea and/or vomiting.
2. Photophobia and phonophobia
Trigger points in Migraine Surgery
Patients who complain of pain above the eyebrows usually have supraorbital or supratrochlear (or both) nerve irritation, mostly due to pressure from corrugator supercilii muscles.
Patients who report their headaches start from the side of the head usually have irritation of either the zygomaticotemporal nerve or the auriculotemporal nerve
Patients who complain of headaches, which start from the back of the eye(s), back of the nose, or from the maxillary sinus area, usually have an intranasal trigger point
Patients with occipital trigger point usually complain of headaches, which start at the back of the head, neck, or sometimes even the shoulder area. Patients describe deep pain in the area, which then radiates to the temporal, parietal, vertex, or even frontal region.
Treatment of Migraine Surgery
1.NASAIDs- Brufen, Diclofenac Sodium, Naproxen
2.Triptans- These are good for acute treatment but should not be taken for more than 8 times in a month for it has side effect. Contraindicated in patients of Coronary artery disease and carotid disease.
3. Caffeine containing analgesic- had history of high dependence rate so not approved and will cause drug withdrawal headache.
Antidepressant- Tricyclic antidepressants (mainly amitriptyline and nortriptyline) and serotonin-nor- epinephrine reuptake inhibitors (mainly venlafaxine) are the mostly used drugs.
• Antihypertensive: Beta-blockers (especially propranolol, nadolol, and timolol), calcium channel blockers (verapamil, flunarizine), a
• Antiepileptics: Topiramate, divalproex sodium, and gabapentin are the most commonly used medications .
• BOTOX(Onabotulinum Toxin A ) injection: It is one of the best treatments of migraine prevention if the trigger points are clearly defined. The only drawback repetition every four to 6 months
It requires a skilled doctors to inject in the sites. The result is doctor dependent and isolation of trigger points
Transcranial magnetic stimulation: Transcranial magnetic stimulation (TMS) is a noninvasive technique that uses fluctuating magnetic fields to induce a current in targeted areas of the cerebral cortex.
There are other neuromodulation devices in the market but there use is limited and they are expensive.
Role of Surgery in Migraine Surgery
Treatment options for migraine, especially in terms of intractable and CM headache is limited. Trigger point deactivation surgery is one of the most promising and effective methods which has minimal adverse effects.
Surgery Involves Decompression of nerves of frontal area, occipital area, temporal area and other area if needed depending on the trigger site.
These are all day care procedure patients are discharged in the evening. The result of the surgery is immediate and patient has shown good result in terms of pain relief for more than 5 years and more. The surgery is a life changing experience to the patient.
All the patients who had undergone surgery says if they knew about this they would have gone earlier. There is satisfaction rate of more than 80% There is no visible scar of the surgery as a plastic surgeon it is all in the hidden areas. The patient can resume work next day or after two days depending on the no of trigger site taken care off.
Our Centre is the only centre in Delhi who is doing Migraine surgery. We have team of experts in our panel. Dr. S.S. Gambhir Senior Consultant Plastic Surgeon is the only qualified surgeon for this type of surgery in Delhi NCR.
Patients Who Want Migraine Surgery in Delhi
If you are interested to go for the procedure then you must send your details we will send you the form which you have to fill about your disease which will help us to guide you correctly.