1. What is Migraine Surgery?
2. ASPS Policy Statement on Migraine Surgery
3. A Comparison of Outcome of Surgical Treatment of Migraine Headaches Using a Constellation of Symptoms versus Botulinum Toxin Type A to Identify the Trigger Sites
4. Anatomical Study of the Lesser Occipital Nerve and Its Potential Compression Points: Implications for Surgical Treatment of Migraine Headaches
5. Anatomical Variations of the Occipital Nerves: Implications for the Treatment of Chronic Headaches
6. Comprehensive Surgical Treatment of Migraine Headaches
7. Comprehensive Criteria for Differential Diagnosis and a Surgical Management Algorithm for Occipital Neuralgia and Migraine Headaches
8. Confirmation of Surgical Decompression to Relieve Migraine Headaches
9. Corrugator Supercilii Muscle Resection and Migraine Headaches
10. Efficacy of Surgical Treatment of Migraine Headaches Involving the Auriculotemporal Nerve (Site V)
11. Five-Year Outcome of Surgical Treatment of Migraine Headaches
12. Factors Contributing to Migraine Headache Surgery Failure and Success
13. In-Depth Review of Symptoms, Triggers, and Treatment of Temporal Migraine Headaches (Site II)
14. Indications and Outcomes for Surgical Treatment of Patients with Chronic Migraine Headaches
15. Introduction to VSI: Migraine surgery in JPRAS open
16. Migraine Surgery: A Plastic Surgery Solution for Refractory Migraine Headache
17. Migraine Surgery Practice Patterns and Attitudes: Implications for Migraine Headaches
18. Minimally invasive nerve and artery sparing surgical approach for temporal migraines
19. Neurovascular Compression‑Induced Intracranial Allodynia May Be the True Nature of Migraine Headache
20. Nonpharmacologic Treatments for Chronic and Episodic Migraine: A Systematic Review and Meta-Analysis
21. Outcome Comparison of Endoscopic and Transpalpebral Decompression for Treatment of Frontal Migraine Headaches
22. Placebo-Controlled Surgical Trial of the Treatment of Migraine Headaches
23. Positive Botulinum Toxin Type A Response Is a Prognosticator for Migraine Surgery Success
24. Refractory occipital neuralgia treatment with nerve decompression surgery: a case series
25. Surgical Options for Migraine: An Overview
26. Surgical Treatment of Migraines by Corrugator Muscle Resection
27. Surgical Treatment of Migraine Headaches
28. Surgical Treatment of Migraine Headache: Back to the Future
29. The Auriculotemporal Nerve in Etiology of Migraine Headaches
30. The importance of surgical maneuvers during treatment of frontal migraines (site I): A prospective, randomized cohort study evaluating foraminotomy/fasciotomy, myectomy, and arterectomy
31. Therapeutic Role of Fat Injection in the Treatment of Recalcitrant Migraine Headaches
32. The Role of the Third Occipital Nerve in Surgical Treatment of Occipital Migraine Headaches
33. The Zygomaticotemporal Branch of the Trigeminal Nerve: An Anatomical Study
34. Treatment of dopplerable nummular headache with minimally invasive arterectomy under local anesthesia

A full one third of patients are not helped by standard traditional therapies, specifically medications designed to either prevent migraine headaches before they start, or those that are designed to relieve symptoms once a migraine has begun. As a matter of fact, 71% of migraine sufferers in the United States are not completely satisfied with their usual acute medical treatment, citing such reasons as delayed and/or incomplete pain relief. Even the most efficacious medications only reduce migraine severity and frequency rather than eliminate them. While these medications may have advantages, they also have disadvantages, including the need to be taken on a regular basis, expense (even with co-pays), and the time it takes for these medications to take effect. They also can have side effects including drowsiness, weight gain, hair loss, and difficulty in concentration or memory issues. Some of these medications, in fact, are contraindicated with certain conditions such as pregnancy, history of coronary artery disease, or stroke. Despite the fact that over 6 million prescriptions are written each year for anti-migraine drugs, over 112 million collective workdays are still lost per year because of migraine headaches, reflecting at least $17 billion in loss of economic productivity. The direct cost of treating migraine headache, excluding over-the-counter medications, is over $1 billion each year, and annual direct cost estimates of migraine treatment can extend to over $7,000 per patient per year.

Alternative forms of treatment include acupuncture, menthol patches, electrical stimulation, magnesium, infusions, massage therapy, chiropractor treatment, and biofeedback, amongst others. Many of these do not have a track record of scientific success with solid data to support their use. However, since the year 2000, there has arisen an innovative surgical technique that can be used to treat patients with chronic migraine headaches. This initially involves the use of botulinum toxin (Botox) and/or nerve blocks to determine whether a patient may, in fact, have “trigger points”, or peripheral nerves of the head and neck that may be compressed by surrounding tissue, including muscle, fascia, bone, or even blood vessels. If it is determined that a patient has a peripheral trigger point, that patient may be a candidate for surgical intervention, specifically a technique used to identify and decompress (or in some cases, ablate) these nerves. This concept and technique have a tremendous amount of data to support its efficacy, safety, and outcomes, with over 30 studies published in peer review journals, and the number increasing on a regular and steady basis. This includes retrospective studies, prospective pilot studies, prospective randomized controlled studies, sham surgery studies, and five-year follow-up studies. These results are also reproducible with at least 5 centers demonstrating that this technique has strong benefit in these patients, including Ohio State University. As a matter of fact, Dr. Jeffrey Janis serves as the Principal Investigator of an IRB-approved multicenter prospective trial on this, as well.

Economically, analyses have been performed specifically looking at the impact of this technique on the healthcare system. In 2012, a paper was published that demonstrated the following economic benefits:

• Migraine medication expenses were reduced by a median of $1,997.26 annually.

• Median cost reduction for alternative treatment expenses was $450 annually.

• Patients had a median of three fewer annual primary care visits for the migraine headache treatment, resulting in a median cost reduction of $320 annually.

• Patients missed a median of 8.5 fewer days of work or childcare annually postoperatively, with a median regained income of $1,525.

• The median total cost spent on migraine headache treatment was $5,820 per year preoperatively, declining to $900 per year postoperatively.

• Total median cost reduction was $3,949.70 per year postoperatively.

• Significant improvements were demonstrated in all aspects of the Migraine-Specific Quality of-Life Questionnaire and the Migraine Disability Assessment questionnaire.

There are very few surgeons who are performing this type of surgery with any sort of significant volume, and there is only one person in this country who has been performing this technique and publishing in this field longer than Dr. Janis, and that is the person who grandfathered the concept and technique. Dr. Janis trained with him as a medical student and has worked with him on anatomic and clinical studies since 2002. There is no one in Central Ohio who has the expertise or experience in this field of migraine surgery, and this is one of the main reasons he was recruited to The Ohio State University.

Patients are treated using an individualized approach but using a multidisciplinary concept. Dr. Janis will only see patients who have been officially diagnosed by a board-certified neurologist. Through the use of history and physical exam combined with the diagnostic modalities of botulinum toxin and/or nerve blocks, as described above, Dr. Janis will isolate or pinpoint the possible peripheral trigger points that the patient has which may be contributing to their migraine symptoms. The patients will then potentially be offered surgical intervention, which can take the form of multiple procedures, all performed in an outpatient setting. The types of procedures performed within that operation are dictated by the number and location of trigger points that are diagnosed in a clinic setting. Dr. Janis has proven results in this field when he was at the University of Texas Southwestern Medical Center as well as at Ohio State University Wexner Medical Center since his arrival in 2013. Among his patients who responded to surgery, average improvement from baseline levels was 96.9 percent. Among the entire patient population, average improvement was 78.2 percent from baseline. This is far more effective than traditional treatments, and reflects a significant impact and improvement on patient’s quality of life that is durable over time.