Michael Chung

By Michael Chung, Kyle Sanniec, Xingchen Li and Bardia Amirlak

Although migraines are experienced by a significant portion of the population, current medical therapies often fail to completely alleviate the symptoms of many migraine sufferers, leading to significant residual disability. Within the last decade, migraine surgery has arisen as a viable option for patients who have exhausted all other medical treatments. Despite early resistance in the headache care community, it has become more accepted due to an increasing number of studies demonstrating efficacy and safety, and increasing evidence supporting the influence of peripheral nerves in the progression of migraine pathophysiology. Yet, it remains crucial to carefully select appropriate surgical candidates based on the assessment of various factors such as medication use, pain distribution, and any other medical conditions that may contribute to headache. It is equally important to ensure that the patient has a strong relationship with a neurologist for optimal medical management and postoperative medical support. After the appropriate trigger sites are identified, various techniques can be used to decompress the involved larger nerves, avulse the smaller nerves, and address any intranasal pathology that could be causing migraines.

Part of the book: Current Perspectives on Less-known Aspects of Headache

By Michael Chung, Xingchen Li, Kyle Sanniec and Bardia Amirlak

Chronic migraines are a common debilitating headache disorder. Recently, there has been increasing interest in the use of onabotulinumtoxinA as a preventative treatment, as studies have shown significant benefits. In line with current accepted theories on the pathophysiology of migraines, the toxin works by both direct and indirect means to prevent peripheral and central nerve sensitization. While efficacy has been established, the technique for extracranial delivery of onabotulinumtoxinA continues to see changes in an effort to seek better outcomes. The PREEMPT injection protocol is the original injection paradigm design targeting broad muscle groups. The ART injection paradigm offers the ability to deliver onabotulinumtoxinA closer to culprit nerves, thus increasing its effect and also decreasing adverse effects. OnabotulinumtoxinA is an effective and well-tolerated option for selective patients seeking relief from migraine headaches.

Part of the book: Current Perspectives on Less-known Aspects of Headache