When non-pharmaceutical
treatments and behavioral changes don’t alleviate migraine symptoms, we might recommend
surgery.
At UT Southwestern
Medical Center, we recognize the toll that migraines can take on a patient’s
life. Our team of neurology experts offers innovative migraine surgery
techniques to help patients move past the pain.
Dr. Bardia Amirlak,
a peripheral nerve surgeon, specializes in treating patients with chronic
migraines. He has worked closely with the pioneer of migraine surgery and has
extensive experience in this area.
Anatomical Regional Targeted (ART) Botox Method
In 2010, the FDA
approved Botox injections as a treatment for migraine headaches. The
traditional method of Botox injection delivers Botox superficially at various
known points of pain throughout the head. In 2016, Dr. Amirlak pioneered a new
method of Botox injection called Anatomical Regional Targeted (ART) injection.
This approach allows for targeted regional injection of Botox at the patient’s site
of pain. The ART Botox technique differs from the traditional method in that
Botox is injected only into sites in which there is pain, and in a much deeper
fashion to target the peripheral nerves that are hypothesized to be causing the
pain.
Surgical Treatments for Migraines
Our team works
closely with patients who require surgery for chronic migraines to develop a
treatment plan that works for their needs.
During migraine
surgery, Dr. Amirlak decompresses the peripheral nerve associated with the area
in which the patient experiences migraines, with a goal of releasing the
pressure points around the nerve fibers. In many patients, this alleviates or decreases
the intensity of future migraine or other persistent headaches.
The specific type
of surgery depends on the nature of the migraines.
Forehead headaches
Pain associated
with forehead headaches typically starts above the eyebrows. Surgery involves decompressing
the peripheral nerves that are compressed by the muscles around the eyebrow.
Temporal headaches
Pain originates in
the temples and might spread upward or downward toward the ears. Treatment involves
decompressing two nerves in this area that are compressed by the fascia around
the temples and temporal vessels.
Rhinogenic headaches
Pain originates
behind the eye, usually from enlarged turbinates that are in contact with the
nasal septum. These migraines can
be treated in one of the following ways:
- Septoplasty:
a surgical procedure that corrects a deviated septum
- Turbinectomy:
the removal of bone and soft tissue in the nasal passages
Occipital headaches
Pain originates in
the back of the head and/or neck. For these patients, Dr. Amirlak has developed
a unique method that expands on the traditional method. He uses an endoscope to
better visualize areas of compression along the greater occipital nerve, allowing
him to decompress and shut off the small branches of the occipital artery to
alleviate pain.
