From the time she was finishing elementary school, Hillary Mickell has battled migraines.

“Sometimes I’d have six in a day, and then I wouldn’t have any for a week, but then I’d have frequent migraines for six straight months,” said Mickell, a 50-year-old San Francisco marketing professional. “When I was pursuing my own startup a few years ago they really ratcheted up. It just takes so much of you to function when you’re dealing with pain like that. It gets to the point where you don’t feel like a whole person.”

Mickell is not alone in her frustrations. Nearly one in five adult women in the US experience migraines which can be devastating. A normal episode can last for up to 72 hours and most people are unable to function normally during that time. Severe, debilitating pain often brings along with it nausea, depression, hypersensitivity, partial paralysis, vertigo, and vomiting. To echo Mickell’s words, it is hard to feel “whole.”

For Mickell, migraines are in her family’s DNA. Her mother, father, and sister also battle chronic migraines regularly. And like anyone living with a chronic condition, Hillary and her family have sought out the right remedy to help manage the pain and frequency of migraines, but finding a treatment is notoriously difficult.

Due to the complex and not yet fully understood nature of migraines, many patients find zero benefit from over-the-counter painkillers, and prescription migraine drugs are only used by one-third of patients. This has left many on their own to explore non-traditional treatments.

“You name it, I’ve done it,” Mickell tells me over the phone. “I’ve had acupuncture, I’ve done the triptans, the vasodilators, worked with chiropractors, took anti-seizure medicines, and even medical marijuana to straight-up Topamax and Vicodin. Everything. All with various levels of managing the pain, essentially.”

Additionally, many of these options have unfavorable side effects, such as sedation “sleepiness” which can further decrease a person’s productivity.

Botox for migraine relief

As experts and migraine sufferers struggle to understand migraines, one of the more recent theories suggests they may be caused by irritation of sensory or “feeling” nerves in the scalp. It was this discovery of trigger points that led to the trial use of botoulinum toxin A or “Botox” as a treatment. Essentially, Botox helps by blocking certain chemical signals from your nerves.

Botox became one of the more effective measures for Hillary who tried it after the FDA approved its use for chronic migraines in 2010. During a typical session, her doctor injected multiple doses into specific points along the bridge of her nose, temples, forehead, neck, and upper back.

Unfortunately, however, Botox is not permanent. The medication wears off, and to continue Botox therapy for migraines, you would need injections every three months. “I tried Botox a few times, and while it did decrease the severity and length of my migraines, it didn’t necessarily decrease the incidences,” said Mickell.

Going under the knife

A few years later, her sister-in-law showed her a study by Dr. Oren Tessler, Assistant Professor of Clinical Surgery at LSU Health Sciences Center New Orleans School of Medicine. In it, a team of plastic and reconstructive surgeons used cosmetic eyelid surgery to decompress, or “free up” the nerves that trigger migraines. The results? An astounding 90% success rate among patients.

For Hillary, the possibility of a reduction in the frequency and severity of her migraines with the added bonus of cosmetic eyelid surgery sounded like a win-win, so in 2014 she located a plastic surgeon in nearby Los Altos, California who had familiarity with nerve-related work.

Her first question for the doctor was whether something as drastic as surgery would actually work. “He said to me, ‘If you’ve done Botox for migraines and that was effective, then that’s a good indicator that this type of surgery could work.’”

The procedure itself is done on an outpatient basis and is typically under an hour for each trigger point that gets deactivated. If successful, the frequency and intensity of migraines is greatly reduced for upwards of two years.

“They basically said ‘There’s no downside. There’s no nerves. Your face is not going to get floppy, and there’s hardly anything that can go wrong. It could just not work.’”

After a lifetime of battling debilitating migraines and trying countless preventative therapies, Hillary was finally migraine free.

“I spent the previous decade devoting half of my time to managing migraines,” Mickell reflected, “but after the surgery I’ve gone almost two years without migraines. I just started having some headaches, but I wouldn’t even compare them to my normal migraines.”

“I’ve told everyone about it,” she adds. “There’s no reason not to. It’s not cost-prohibitive. And the level of impact is astounding. I can’t believe people don’t know about it and don’t talk about it.”

For those considering eyelift surgery for migraines, we asked plastic surgeon Catherine Hannan MD for advice.