Chronic Migraine

Migraines are a common cause of recurrent headaches. Treatments usually consist of lifestyle modifications (i.e. avoiding triggers), medications that abort and/or prevent the headache attacks, and botulinum toxin (Botox) injections.

In some cases, migraines can be severe and frequent despite the above measures. For patients who are affected by migraines in their daily lives and have not found relief with these treatments, surgery can sometimes be considered.

There are several surgical options for chronic migraine, including sphenopalatine ganglion (SPG) rhizotomy, occipital nerve stimulation, and trigeminal nerve stimulation. The latter two can be effective, but they require a permanent stimulator implant that is not MRI compatible, and they are seldom covered by insurance plans, so I generally do not offer them to migraine patients. If surgery is being considered, SPG rhizotomy is a reasonable starting place for some patients, in part because it is safe, it does not require an incision, implant, or anesthesia, and it is performed on an outpatient basis.

If you live near Denver and suffer from chronic migraines or another facial pain disorder, please consider meeting me in consultation to learn whether you might be a candidate for one of the above therapies.

Importantly, patients with chronic migraine should first see a neurologist (I am a neurosurgeon - not a neurologist) before considering surgery. I perform procedures, but I do not prescribe migraine medications. There are many effective migraine medications, and surgery should only be a last resort.