Quick Hits!: Facial Pain Surgery: Surgical Strategies for Treatment-Full Presentation: Facial Pain Surgery: Surgical Strategies or Treatment

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Video Summary

This session highlighted the collaboration between the Migraine Surgery Society and ASMS, focusing on integrating migraine surgery into current practices. Dr. Afifi opened with a discussion on post-craniotomy headaches—a predictable, easily treatable condition often caused by nerve injury or hardware irritation. Surgical removal of irritating hardware, nerve decompression, or excision can dramatically alleviate pain, sometimes with simple procedures performed even by primary care doctors.<br /><br />Dr. Jonathan Black shared his experience over ten years incorporating migraine surgery, emphasizing evidence from multiple studies demonstrating significant long-term improvement in migraine sufferers following nerve decompression or removal. He described key migraine trigger sites: frontal (supraorbital and supratrochlear nerves), occipital, and auriculotemporal nerves. Techniques include muscle resection, decompression, artery resection, and fat grafting. He stressed the importance of proper patient screening using pain drawings, nerve blocks, and Doppler ultrasound to confirm nerve involvement for surgical success.<br /><br />Dr. Ali Tatanchi addressed rhinogenic migraine triggers caused by nasal anatomical issues such as septal deviation, turbinate hypertrophy, and contact points, which irritate mucosa and contribute to headache symptoms. Diagnosis includes symptom patterns, CT scans, nasal endoscopy, and mucosal blocks. Surgical treatment involves septoplasty and turbinate reduction aimed at eliminating contact points without compromising mucosa. Complications are rare but careful surgical technique is essential.<br /><br />Audience questions focused on nerve block techniques, differentiating nerve pain from musculoskeletal pain, and the relationship between nasal structural issues and headache. Overall, the session emphasized multidisciplinary approaches, thorough patient evaluation, and tailored surgical techniques to significantly reduce migraine and post-craniotomy headache suffering. The collaboration promises further integration of migraine surgery into facial and craniofacial practices.

Keywords

Migraine Surgery Society

ASMS

post-craniotomy headaches

nerve decompression

migraine trigger sites

muscle resection

rhinogenic migraine

septoplasty

nerve blocks

multidisciplinary migraine treatment