18% of the women and 6% of the men have migraine. The coincidental detection about Botox injections are helping the treatments of some patients for headache, has been opened the way of migraine headache’s surgery.

The surgical intervention of eliminating the frowning eyebrows (corrugator release) during the endoscopic brow and eyebrow lifting operation, is releasing and relaxing the nerves between this muscles like Botox. Therefore it has been come to the conclusion that the eliminating the pressure on the sense nerves is preventing the triggering or starting of the headache.

The studies have been focused on eliminating (deactivating) the trigger points of migraine headache by surgical methods and applications. For determining the trigger points first a Botox injection will be applied to the patients.

After four weeks, if the patient have decreased migraine headache and if some improvisations have been determined, the surgery will be performed. After a one year follow-up period, the scientific studies have been proved that the frequency, period and intensity of the migraine headaches have 50% reduced for the patients who undergone the surgical operations. These studies have been reflected to the annual productive power loss and treatment costs, and after the calculations it will be discussed today in the United States of America if the migraine surgery treatment will be covered by the health insurances.

Four main triggering points have been determined;

Eye surrounding, brow area (the area in which the supraorbitale and trochlear nerves are raising and passing through the corrugator supercilii, depressor supercilii and procerus muscle fibers)

Temporal region (the area in which the zigomaticotemporal branch of the trigeminal nerves is raising from the temporal muscle)

Nape area (the area in which the small and large 3rd occipital nerves are raisin between the nape muscles)

Nose origin (reflecting into the eye)

Let us make a short overview to these triggering points;

1st area is the place where Botox applications will be made against the frowning eyebrows ans it is easy to access endoscopically from the hairy skin. Botox will give a result in 5-7 days, but having a permanent result with endoscopic surgery the muscles which are making the pressure on nerves must be determined and they should be expurgated (one of the factors that prevents the full-success is continuing pressure of the muscle tissue over the nerve)

Complete endoscopic removal of the zigomaticotemporal branch of the trigeminal nerve. This nerve branch can be seen during the endoscopic subperiosteal mid-face lifting surgery and its ablation is very easy.

The large occipital nerve which gives the nape sense and small occipital and 3rd occipital nerves can have pressure when they are raising from the muscles in the area (occipital, trapezius, splenius, semispinalis capitis, sternocleidomastoid muscles). This is the non-endoscopic part of the surgery. Its anatomy is pretty standart. The nerve is large enough to see with naked eyes

As the 4th area is triggering the inner nose irritation which is familiar for ENT (ear, nose and throat) specialists, these are the migraine headaches that the patients are describing as it is coming from the inside of the eye (with the relations of concha pathologies, concha bullosa, septum-concha). Can be corrected with conchaplasty and septoplasty.

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