Most people complain of headaches of different types and characters. Strong headaches affect people’s social life negatively and cause serious loss of workforce and performance.
One of the most common headaches of different types, perhaps the most famous, is MIGRAINE. The incidence of migraine is 3 times higher in women than men and it is thought to affect 10-15% of the population.
Why Migraine Occurs
Although different theories have been suggested as to why migraine originates, the exact cause of the disease is still unclear. Genetic predisposition and environmental factors are known to be important for migraine. Different scientific studies have shown that neurons in the brain cortex can be more easily stimulated than normal in patients with migraine pain. It was also found that the dysfunction of sensory receptors that perceive pain and ache also causes migraine.
Migraine has 4 main triggering points. The first is the trigeminal nerve end located in the nasal septum. Again, the contraction of the strong muscles in the forehead, especially the inner and middle parts of the eyebrows, can cause the sensory nerves to be stimulated here. Migraine attacks occur when the sensory nerves are triggered by the activity of the temporal muscle on the side of the head and the semispinatus muscle on the back of the head.
Migraine Attacks and Symptoms
The frequency and severity of migraine attacks vary from person to person. Attacks can be avoided within hours or may last for days. Migraine attacks usually start in the third decade between the ages of 20-30 and occur in four-stage attacks.
Prodromal period is usually seen a few days before the attacks and includes symptoms such as restlessness, tension, constipation, stretching, and frequent urination. Patients may understand that migraine attacks come from changes in mood.
Aura Neurological disorders that occur before migraine attacks. Although there may be signs of muscle weakness, speech and visual disturbances, light in the eye, migraine without aura is seen in most of the patients.
Pain Attack migraine pain is the period that occurs and may end in hours or may last for days. Migraine usually begins in areas such as the forehead, the back of the head, the side of the head and the back of the eye. The starting point of pain also helps to choose the point of migraine surgery.
Postdromal or in the post-attack period, patients feel tired, sluggish and exhausted. However, there is a feeling of relief as the attack is over.
Every patient with headaches should be evaluated by a neurologist. Life-threatening conditions such as vascular complaints, tumor masses and cerebral hemorrhage which are among the causes of headache should be evaluated and excluded in detail.
Migraine treatment can be divided into two main categories as drug treatment and surgical treatment. Drug treatment is performed by neurologists (experienced neurologists specialized in headaches) and can be very effective in treating or reducing the frequency of acute migraine attacks. It is also necessary to change the lifestyle and habits such as smoking, alcohol and caffeine avoidance in order to prevent migraine
Migraine surgery candidates are a group of patients who do not respond to medical treatment but it should be noted that SURGICAL TREATMENT IS NOT THE SOLUTION FOR THE TREATMENT OF ALL MIGRAINE PATIENTS. Surgical treatment may be beneficial and it has been found out that surgery has no positive effect on healing in some patients.
Botulinum Toxin in Migraine Treatment
It has been found out from the feedbacks coming from the patients that Botulinum Toxin (BOTOX) injections used for aesthetic purposes reduce the frequency and severity of migraine attacks. After the botox treatment of the forehead for the wrinkle treatment, patients who had recovered from migraine pain have popularized the idea that migraine can be treated with the recovery of sensory nerves from muscle activities and paved the way for the development of new surgical techniques.
We have already mentioned that the 4 main triggering points of migraine are the forehead, temples, upper nape and around the nose and eyes. Migraine surgery aims to eliminate or reduce the factors that cause irritation (sensation) in the sensory nerves in these areas.
Sensory nerves in the forehead may cause migraine attacks in response to movements of the muscle group located in the middle of the eyebrows. It has been observed that migraine attacks are reduced by removing the muscles around the nerves or reducing the pressure on the nerves (decompression therapy) by reaching this area from the eyelid or forehead.
It is also thought that turbinate hypertrophies (nasal polyps), bone and cartilage curvature, which cause irritation of sensory nerves within the nose, trigger a migraine. It is also known that headache complaints of some patients have decreased after nasal surgery.
Different trigger points such as forehead and nose area, where migraine starts, are identified and surgical procedures are performed to relieve the nerves.
To sum up, migraine surgery should be considered as an alternative treatment in patients who do not respond to medical treatment. Although the place of surgical operations in the treatment of migraine is still controversial, patients who recover from headaches after migraine surgery support the steps in this regard. It is foreseen that surgical methods will become more widespread in the treatment of migraine which decreases the quality of life with the right patient selection, full communication between doctor and patient about the outcomes of the surgery.