Surgery – What to expect

Surgical treatment with the Oxford Migraine Practice will be undertaken at one of Oxfordshire’s leading private hospitals, and can be performed either under local anaesthetic (with you awake) or under general anaesthetic (with you asleep). Most patients will prefer having some sedation if having these procedures done under local anaesthetic. Any surgery involving the occipital trigger site at the back of the head will require a general anaesthetic. You will be assessed by a consultant anaesthetist to ensure you are fit for surgery, and you may also need some pre-operative blood tests. We will usually recommend a one night stay after any procedure performed under general anaesthetic.

The surgery lasts from anywhere between one to four hours, depending on the number of trigger sites that we are operating on.

Recovery

Time to recovery will depend on which procedure or combination of procedures is performed. The first two weeks of recovery are the hardest. The nerves will swell and as a result, patients may find that their migraines get transiently worse during this period.

For this reason, patients will generally need two weeks off work to recover, and we strongly encourage you to refrain from any exercise or strenuous activities during this period. Bruising and swelling is to be expected, particularly at the frontal trigger site, where eyelid swelling can look quite dramatic. Cooling with eye pads can help to reduce the swelling and this will help make a difference to any swelling. Most of this swelling settles within two to three weeks, but can take longer in some patients. Swelling at the other surgical sites is less pronounced.

There will be stitches at the incision sites. These can be removed at one week postoperatively. This can either be done by our team, or it can be done locally if you live far away

Follow up

Some patients will notice an improvement in their headache symptoms within weeks or even days of surgery, but for most patients it takes a little longer. For this reason, all patients who have had surgery will get a follow-up appointment with us at 3 months post-operatively, either online or face-to-fac. You will be asked to complete a migraine diary and questionnaires prior to your follow-up consultation to help us assess the degree of improvement.

RISKS AND SIDE-EFFECTS

Migraine surgery is safe and relatively low-risk. We are not operating on your brain or on any structures inside your skull, and we do not need to go much deeper than your skin to locate and decompress the nerves at the trigger sites. Published data from thousands of patients who have undergone migraine surgery show that it is very safe.

However, any medical intervention carries risks, and these need to be carefully weighed up against the potential benefits of surgery. We will discuss these with you in detail before you decide to proceed with surgery.

General risks of surgery

• Infection (less than 1%). The majority of surgical site infections can be treated with a course of oral antibiotics.
• A small amount of ooze/bleeding from the wound is to be expected, especially since the head and neck region is not an area where we routinely apply sticky dressings. A haematoma (collection of blood under the skin) is much rarer, but may require releasing with surgery.
• Poor healing of skin incisions.
• Risks of general anaesthetics such as blood clot, heart and lung complications – these are rare complications and we take multiple precautions to prevent them. Your consultant anaesthetist will discuss these with you in detail before the procedure.

Specific risks

• Temporary numbness or strange/burning sensations are common whenever one has operated on a nerve. In the vast majority of patients, these sensations are transient and will settle over the course of several weeks, but permanent numbness or other changes in skin sensation are possible.
• The migraine headaches can get transiently worse due to the swelling from surgery. This will improve over a few weeks as the swelling subsides. For migraines to become permanently worse is a theoretical possibility; there is currently no data on this.
• While we make every effort to hide your scars in natural creases, poor or visible scarring is a potential risk.
• Mild asymmetry in muscle function of the frowning muscles after frontal surgery.
• Scar alopecia – scars within the hair-bearing scalp can mean that hairs will not regrow through the width of the scar. This will only be noticeable if you wear your hair very short.
• No improvement in migraine or headache symptoms (5-10%).
• Uncovering other trigger sites (see separate section).