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Finding the Right Chronic Migraine Treatment

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8 Medical Procedures to Ease Migraine

Medically Reviewed By Susan W. Lee, DO

Medical procedures can help improve migraine severity and frequency or prevent migraine episodes. Options include nerve decompression surgery and injected medications, as well as noninvasive procedures like nerve stimulation. For some people, first-line migraine treatments such as medication and trigger management don’t improve symptoms enough.

In such cases, doctors may recommend medical procedures for migraine. Your medical team can advise on which procedures may be safe and effective for you.

Read on to learn more about migraine medical procedures, including their processes, outlook, and side effects.

1. Nerve decompression surgery

Someone leans against a stone wall while standing in direct sunlight.
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Some people’s migraine episodes are caused by Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source nerve compression. Nerve compression or a pinched nerve is when surrounding tissues such as bone, cartilage, or muscle apply too much pressure to a nerve.

With nerve decompression surgery, surgeons will make incisions around the neck or forehead to remove the tissues affecting the nerves and help stop Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source migraine. Surgeons may then place fat around the nerve, providing padding and stability.

Typically, doctors consider nerve decompression only if other treatments haven’t helped, as it may not be effective for everyone.

Learn more about nerve compression, including its symptoms, causes, and treatment.

Outlook and side effects

Doctors often use general anesthetics for surgery and to prevent pain.

As with any surgery, nerve decompression can carry risks, such as:

  • infection
  • blood clots
  • nerve damage

However, doctors will work with you to reduce risks, support your recovery, and improve your outlook.

Research also suggests that, for some people, nerve decompression surgery effectively treats migraine when other approaches haven’t worked.

2. Greater occipital nerve (GON) block injections

The greater occipital nerve (GON) runs up both sides of the back of the head. Sometimes, oversensitivity in the GON leads to headache disorders such as migraine.

A GON block involves injecting anesthetics, steroids, or both into the back of the head with a thin needle to relieve migraine. Though the injection can cause stinging, the pain is typically short-lived and manageable.

Outlook and side effects

GON blocks can provide quick, effective pain relief for many people and are typically considered safe Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source . Still, they can lead to side effects such as:

  • bruising
  • dizziness
  • worse migraine pain for a few days
  • negative reaction to the anesthetic or steroid

Some people may also experience tenderness or numbness that spreads around the injection site for a few hours.

Generally, GON blocks provide only a few weeks of relief from migraine pain, but some people experience longer-lasting benefits like reduced migraine severity or frequency.

3. Botulinum toxin (Botox) injections

Experts suggest Botox injections can reduce Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source migraine frequency and severity. A type of botulinum toxin called onabotulinumtoxinA may also help prevent Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source chronic migraine.

Botox injections work by stopping the release of brain chemicals that transmit pain signals. They may also help reduce Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source tension headaches by encouraging muscle relaxation.

Injection schedules can vary per person. Generally, the standard protocol for migraine treatment with Botox is around 31 injections, although some doctors may use more. These injections are given a few at a time every 3 months.

Learn more about using Botox to treat health conditions.

Outlook and side effects

It is possible to experience Botox side effects such as:

  • neck pain
  • muscle weakness
  • eyelid or skin drooping
  • rarely Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , botulism infection

However, research reports that Botox injections are usually safe and well tolerated and can be effective at reducing pain and improving quality of life.

Botox may be beneficial if other migraine treatments haven’t helped and you have chronic migraine.

4. Vagus nerve stimulation

Noninvasive vagus nerve stimulation (nVNS) sends mild electrical stimulation through the skin, activating the vagus nerve and relieving pain.

As per its name, it is noninvasive and should not be painful. To perform nVNS, you will hold a gammaCore device to the skin of your neck. You can do this during migraine episodes to relieve pain or as a daily preventive therapy.

Outlook and side effects

A 2023 review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of trials suggests that nVNS may reduce headache intensity and the number of days with headache, depending on the vagus nerve treated.

Researchers from the review also reported nVNS as safe and well-tolerated for most people.

Some possible side effects include:

  • skin discoloration or irritation
  • muscle contractions
  • mild to moderate pain

Learn more about nVNS, including its procedure, safety, and effectiveness.

5. External trigeminal nerve stimulation

External trigeminal nerve stimulation involves using a Cefaly device to generate pulses and stimulate the trigeminal nerve. This is done to provide a sedative effect and reduce the number of migraine episodes.

You can use a Cefaly device at home, and it is the only medical procedure for migraine that doesn’t need a prescription or referral from a healthcare professional. However, talk with a doctor for advice before trying external trigeminal nerve stimulation.

Outlook and side effects

2019 trial Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  suggests external trigeminal neurostimulation can significantly reduce head pain while being relatively safe.

However, the procedure can still lead to mild or temporary Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source side effects, such as:

  • skin irritation
  • nausea or vomiting
  • dizziness
  • worse headache
  • sweating
  • sleepiness

6. Single pulse transcranial magnetic stimulation (sTMS)

Another noninvasive treatment is sTMS. It involves using a device that produces magnetic pulses to interrupt brain activity that causes migraine.

To perform sTMS, a doctor will hold an sTMS device to the back of your head for less than a minute once every few months.

Outlook and side effects

Experts report that sTMS is a painless procedure that can effectively relieve pain Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source for many conditions, including migraine.

However, some people have reported side effects such as:

  • nausea
  • sensitivity to light or sound
  • dizziness or lightheadedness
  • tinnitus

These side effects are often mild or temporary.

7. Biofeedback

Biofeedback is a mind-body therapy that helps you improve control of your body’s functions and manage pain or migraine triggers such as stress.

The procedure works by using an electrical device that tracks your body responses, such as muscle tension. By reading or listening to the monitor, you can become aware of your responses and relax your muscles.

You can learn to use biofeedback with a doctor and continue the procedure at home with a portable device.

Doctors may also recommend relaxation training or deep breathing alongside biofeedback, as they can help you learn how to physically and mentally relax.

Outlook and side effects

According to the American Migraine Foundation, biofeedback and relaxation training typically lead to a 45–60% decrease in headache severity and frequency.

Biofeedback and relaxation training are also considered very safe Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source and have few complications. However, some people may find the procedures difficult to follow or fit into daily life.

Read more about biofeedback, including how it works.

8. Acupuncture

Acupuncture uses the strategic placement of needles to alleviate targeted symptoms, including pain.

With migraine, acupuncture may relieve pressure points and slow pain transmission. However, more research is needed to understand how exactly acupuncture improves migraine.

Outlook and side effects

Research from 2016 suggests acupuncture can reduce headache frequency. Still, more studies are needed to confirm the safety and effectiveness of acupuncture for everyone.

Only a licensed acupuncturist is allowed to perform acupuncture. Talk with a doctor for their recommendations before considering acupuncture.

Summary

Medical procedures for migraine include nerve decompression surgery, nerve block injections, and nerve stimulation. Some people also find Botox injections, biofeedback, or acupuncture effective.

Many of these procedures have minimal risks of side effects. However, your outlook from these treatments can depend on personal factors.

Talk with a doctor for advice if you have questions about migraine treatment.

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Medical Reviewer: Susan W. Lee, DO
Last Review Date: 2024 May 2
View All Finding the Right Chronic Migraine Treatment Articles
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