Migraine Surgery in San Francisco & Sonoma County CA

Migraine surgery involves deactivation of trigger sites involving the nerves of your head and neck. At Bay Area Esthetics Plastic Surgery our goal is to help determine all of the potential sources of your migraine headaches, then systematically develop and execute a surgical plan based on the involved nerves. After undergoing migraine surgery, most of our patients have a significant improvement in their symptoms, and some go on to live completely free of migraine headaches.

An ideal functional outcome reduces the frequency, intensity, and duration of your migraine attacks, or can eliminate your migraine headaches all together.

• Dr. Pourtaheri is a migraine surgery specialist with an advanced understanding of facial and head and neck anatomy. Migraine surgery is one of the most gratifying procedures that he performs to improve the quality of life of his patients.
• Dr. Pourtaheri systematically evaluates all of the potential nerves involved in triggering your migraine headaches before and after surgery so that we can track your progress toward a goal of living migraine-free.
• Dr. Pourtaheri is one of the few plastic surgeons who received extensive training in migraine surgery. During his six years of residency, Dr. Pourtaheri trained with the pioneer of migraine surgery, Dr. Bahman Guyuron, learning all of the advanced techniques needed to identify and treat candidates for migraine surgery.
• Dr. Pourtaheri completed a craniofacial fellowship, perfecting his understanding of anatomy and approaches to perform these surgeries of the head and neck more quickly, safely, and accurately.
• Dr. Pourtaheri has given numerous national and international presentations himself, and has published several articles on the subject in peer-reviewed scientific journals.

Migraine surgery is best performed after you have been diagnosed by a neurologist and have tried medical therapy first. It may be best to perform your surgery after puberty, as hormone cycles can impact migraine symptoms and in some cases you can “grow” out of them. However, there may be reasons to perform surgery sooner, particularly if the symptoms fit a pattern that points to a clear trigger site, and the headaches are significantly interfering with your life or performance at school or work. If you have questions about the ideal timing for a procedure, please request a consultation or call / text 415-523-5235 to contact us.

Common reasons why patients pursue migraine surgery include:

• Frequent, debilitating migraine headaches
• Migraine headaches inadequately treated after taking medications for three months or longer
• Neck strain or soreness associated with migraine headaches
• Temporomandibular joint pain or clenching associated with migraine headaches
• Pain that starts near the eyebrows or forehead prior to migraine headaches
• Pain near the back or top of the head prior to migraine headaches
• Pain that starts in the temples prior to migraine headaches
• Nasal congestion or pain behind the eyes prior to migraine headaches

Migraine surgery can help reduce the frequency, intensity, and duration of migraine headaches and potentially provide patients with a life free from migraine-related pain. If you are suffering from migraine headaches and were diagnosed by a neurologist or migraine headache specialist you may be eligible to receive migraine surgery. If you were prescribed migraine headache medications that did not work well enough, or caused unwanted side effects, you may benefit from migraine surgery.

If you can point to specific area(s) where your headaches start prior to a migraine attack, you may be a good candidate for surgery. If you have had migraine surgery elsewhere that did not provide enough benefit, Dr. Pourtaheri will be happy to discuss if there is anything else he can do to help. To find out if you are a candidate, please contact us through our confidential online form or call / text 415-523-5235 to schedule a consultation with Dr. Pourtaheri.

Before your first visit, you will be asked to complete an intake form to document your personal and medical history, prior surgeries, dental work, medications, and allergies. We may also ask you to complete a headache journal prior to your visit, recording each day in the past 1-2 months that you have had a migraine headache and where the location(s) from which your pain started. At your visit we will review your headache journal and migraine symptoms. We will also want to learn more specifically about any migraine medications you have tried or are currently taking, and any prior head and neck procedures performed. If you have received BOTOX for your migraine headaches we would like to know when the last time you had this done and if there was benefit.

We will examine your head and neck, including the inside of your nose. The examination will not be uncomfortable. A CT (computed tomography) scan may be ordered and used to plan your surgery. Sometimes a targeted nerve block or BOTOX injection is used to help treat your migraine headaches and confirm areas that would benefit from migraine surgery.

We will work closely with your neurologist / headache specialist to obtain your records and discuss the plan with them. Headache specialists are a vital team member when it comes to managing your migraine headache medications after surgery, and potentially weaning you off of them. You will have a chance to review the plan with Dr. Pourtaheri prior to surgery.

Patients suffering migraine headaches have central pathology, predisposing them to developing these debilitating attacks. However, there are nerves outside of the skull that provide input to the brain that can be abnormal or irritated and contribute to the development of migraine headaches. The diagram below was developed by Dr. Pourtaheri to help explain the relationship between peripheral nerves and the central nervous system as it relates to migraine headaches. If we deactivate the triggers, we may be able to stop the headaches from happening.

Dr. Pourtaheri is meticulous and scientific when it comes to diagnosing the source of your migraine headaches and developing a surgical plan specific to you. Your procedure can generally take 1 to 3 hours depending on the approach, number, and location of the nerves involved. The overall technique will involve relieving the nerves at each identified trigger site.

Below is a list of the most common trigger sites that we can deactivate to relieve migraine headaches.

• Frontal Trigger Site Deactivation – A frontal trigger site for migraine headaches involves the supraorbital and supratrochlear nerves. These nerves exit the skull above your eyes and travel up past your eyebrows to your scalp. Migraine headache pain that starts in this area, typically in the afternoons or related to stress, and in the presence of strong frowning muscles (11’s) may involve this trigger site. Surgery for this trigger site can be accomplished through a small upper eyelid incision or small incisions in the hair-bearing scalp. We can combine this procedure with decompression of a temporal trigger site and a brow lift or an upper eyelid blepharoplasty in patients also bothered by heavy upper eyelids or sagging eyebrows.
• Temporal Trigger Site Deactivation – There are two main nerves associated with trigger sites near the temple, the zygomaticotemporal and the auriculotemporal nerves, both branches of the trigeminal nerve. The former, exits the temporalis muscle, just above and slightly in front of the ear while the latter is located more superficially near the tortuous blood vessels at the small depression just above the outside corner of the eye. Migraine headache pain that starts in these areas or is associated with clenching / grinding the teeth or temporomandibular joint pain may involve these trigger sites. Surgery involves removal of the involved branches of nerves or blood vessels through very small incisions. Some patients may also benefit from temporomandibular joint treatments or fat grafting.
• Rhinogenic Trigger Site Deactivation – A rhinogenic trigger site is perhaps one of the oldest known trigger sites associated with headaches. It involves nerve branches inside the nose. Pain behind the eyes, typically early in the morning, worsened by weather or hormone changes may involve this trigger site. The approach for surgery is similar to a septoplasty, performed completely inside the nose leaving no visible scarring. Patients who undergo this surgery may also benefit from reduced nasal congestion and improved breathing.
• Occipital Trigger Site Deactivation – Occipital trigger sites for migraine headaches most commonly involve the greater occipital nerves but may also involve the lesser or third occipital nerves. These nerves exit the upper neck and travel up the back of the head and behind the ear, reaching the top of the scalp. Migraine headache pain that starts in these areas and is associated with neck pain, tight neck muscles, stress, or heavy exercise may involve these trigger sites. The approach for this surgery is performed through small incisions hidden in the hair on the back of the neck to remove the involved portions of muscle, fascia, blood vessels, or nerves.
• Nummular Trigger Site Deactivation – A nummular headache / trigger site involves what is classically described as a “coin shaped” area on the side or top of the scalp that experiences a sharp or stabbing type pain when active. The approach for surgery involves a small incision made in the hair-bearing scalp to remove the involved branches of blood vessels or nerves.

We can perform your migraine surgery procedure in San Francisco or Sonoma County based on your preference. Certain procedures can be performed in the office under local anesthesia, while others may require general anesthesia. Almost all patients go home the same day.

You will be given antibiotics on the day of surgery and you may also need to take them after surgery if the nose was involved. We also prescribe pain medications to limit your discomfort. You will receive care instructions before and after surgery and have plenty of time to ask questions. If you anticipate having a friend or family member care for you after surgery, it is helpful to have them come to your visits before and after surgery to review these instructions.

After surgery, sometimes your headaches can become worse for a few weeks until healing has completed. Regular walking is encouraged to prevent blood clots, starting the morning after surgery. You can shower the day after surgery.

We will see you again in 1-2 weeks after surgery to check on your wound healing. We will schedule additional visits to check on your healing progress; some of these can be done virtually if you live out of town. If you are ready to take the next step and learn more about migraine surgery to improve your quality of life, please contact us online using our confidential form or call / text 415-523-5235 to schedule a consultation with Dr. Pourtaheri