Migraine headache can be a debilitating condition that confers a substantial burden to the affected individual and to society. Despite significant advancements in the medical management of this challenging disorder, clinical data have revealed a proportion of patients who do not adequately respond to pharmacologic intervention and remain symptomatic. Recent insights into the pathogenesis of migraine headache argue against a central vasogenic cause and substantiate a peripheral mechanism involving compressed craniofacial nerves that contribute to the generation of migraine headache. Botulinum toxin injection is a relatively new treatment approach with demonstrated efficacy and supports a peripheral mechanism. Patients who fail optimal medical management and experience amelioration of headache pain after injection at specific anatomical locations can be considered for subsequent surgery to decompress the entrapped peripheral nerves. Migraine surgery is an exciting prospect for appropriately selected patients suffering from migraine headache and will continue to be a burgeoning field that is replete with investigative opportunities.
Ann Arbor, Mich.; and Cleveland, Ohio
From the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health Systems, and the Department of Plastic Surgery, Case Medical Center.
Received for publication April 24, 2010; accepted June 23, 2010.
Disclosure:The authors declare that they had no financial interests or commercial associations during the course of this study. This article did not require any sources of funding.
Paul S. Cederna, M.D.; Section of Plastic and Reconstructive Surgery; University of Michigan Health Systems; 1500 East Medical Center Drive; 2130 Taubman Center, SPC 5340; Ann Arbor, Mich. 48109; firstname.lastname@example.org