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After extensive reviews and a number of studies, the FDA approved the use of Botox for the treatment of chronic migraine headaches. It is interesting that this came shortly after Allergan, the maker of Botox, was fined 600,000 dollars for advertising the use of Botox for the treatment of headaches and other unapproved uses.
Botox for migraines works mainly by temporarily paralyzing the muscles pinching certain nerves in the head and neck. There are 6 nerves that could be involved (a pair of supraorbital nerves, a pair of Zygomatico-temporal branches of the trigeminal nerve, and a pair of greater occipital nerves). These nerves run either through or very close to facial muscles. So by temporarily relaxing the muscle the nerve can breathe and is no longer irritated, this calms the nerves endings and prevents the migraines from occurring. However, the main problem with Botox is its temporality. Patients would have to come back to the doctors for repeated injections every 8-12 weeks, and since Botox is a protein some patients develop immunity to it.
Surgery on the other hand provides a permanent relief. This would avoid having a patient see the doctor every 3 month for many years (I personally wouldnt want to see any doctor that often) . Removing these muscles has no effects on function, except for erasing some wrinkles between the eyebrows. Surgery is performed on a day surgery basis, where all involved nerves are released during the same procedure through small incisions in the eyelids, or in the scalp hidden behind the hairline.
Almost all of our patients undergoing migraine surgery leave the hospital on the same day of surgery. Most patients have numbness in the forehead for a few weeks. Surgical results have been very encouraging. About 30% of patients are completely cured of their migraines, but the far majority, 90% are having a significant improvement in their symptoms.
One of the most rewarding aspects of performing migraine surgery is hearing how it has changed a patients life. A few weeks ago I received 2 emails from two different patients on the same day who wanted to share with me how much surgery has changed their quality of life. This is also one of the few surgeries where patients enter the operating room so excited about the better life waiting for them.
Like any other surgery, an educated patient is the best patient. Learn more about migraine surgery by visiting at www.migrainesurgerycenter.com

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