Posted in: NYPS Group News , Wednesday June 3, 2015
Photo: R. Nial Bradshaw, Flickr/Creative Commons

A  Q & A with Michael Dobryansky, MD, FACS

Migraine headaches are a painful puzzle that an estimated 36 million American sufferers have yet to solve.  With the increasing use of Botox in the general public however, a potential new solution for some types of migraines has emerged.

Q. How does plastic surgery work to remedy or cure migraines?

A. The procedures were pioneered by Dr. Bahman Guyuron head of plastic surgery at University Hospitals Case Medical Center in Cleveland, Ohio. Guyuron came upon the beneficial effect of plastic surgery for migraine sufferers when forehead lift patients were reporting that their migraines had disappeared.  He also found that patients receiving Botox injections in or near what are commonly called “trigger areas” who were also migraine sufferers got a side benefit–their migraines either improved or disappeared.

Through clinical placebo trials, Guyuron found that migraine sufferers benefited from regular Botox injections at or near migraine “trigger points” (temples, neck, etc.)  Subsequently, Guyuron developed a procedure called, “Nerve Decompression Surgery” which allowed targeted migraine patients to “decompress” nerves at those points permanently.

After five years, 61 out of the 69 patients who had the surgery continued to have at least partial relief from their migraine pain.  Sixty percent of the group said the headaches decreased significantly and around 30 percent said that the migraines disappeared entirely.  I am one of a select group of about 250 surgeons that Dr. Guyuron has trained personally in the technique.

Q. Are all migraine sufferers potential candidates for this surgery?

A. Not all. Migraines that are triggered by hormonal issues, for instance would not benefit from the Botox treatment or the surgical solution.

This is why the procedure is first tested by using temporary Botox injections at potential trigger points.  If the patient regularly receives relief, a more permanent surgical solution can be considered.

Q. Can you simply continue the Botox instead of having the surgery?

You can, but the Botox injections only last for a 3-5 month cycle and need to be repeated to continue the benefit.  The FDA has approved the use of Botox for migraines but right now few insurance carriers pay for the procedure in part or in full, so it may be costly (as well as time consuming) to pay for the Botox procedures on a regular basis.

Q. Does insurance cover the surgery?

A. Some insurance carriers are now covering the surgery. But if your insurance does not cover the cost (which can range from $5,000-$15,000 depending on how many trigger points need to be dealt with) the long-term cost of many Botox injections may outweigh the onetime cost of the surgery

Q. Do you do the procedure in a hospital or on an outpatient basis?

A. Surgery is done on an outpatient basis at our state-of-the-art facilities at LIPSG. Each potential trigger point takes about 45 minutes for surgical decompression, so the length of surgery would be dependent on how many of these points are causing your migraines. We test this beforehand with Botox injections at the potential trigger points.

Q. Can you do the procedure in tandem with a facelift?

A. Yes, it can be done at the same time as a facelift but each patient is unique and is evaluated on a case-by-case basis. Sometimes trigger points are located in areas like eye areas and forehead, and if plastic surgery at those locations is desired you could combine both and wake up both looking and feeling better.

If you have questions about this surgery, or want to know more, email us at

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