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.
Should people who suffer from chronic migraines head under the knife before ruling out other procedures?
Migraine sufferers should first see a neurologist to get a thorough history and physical evaluation. Many neurologists start with pharmacologic therapies since many patients benefit from those. Additionally, since the vast majority of plastic surgeons do not yet offer this procedure, it can be challenging to find a provider outside of an academic center in a major city.Catherine Hannan, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Has Botox had any long-term success with patients?
The botulinum toxin consistently wears off in the majority of patients after about 3 months, so it is an effective treatment but not a cure.Catherine Hannan, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Is getting the plastic surgery a cost effective solution vs. Botox or less effective alternative treatments?
Most neurologists attempt medications first, and then possibly Botox injections, well before surgery becomes an option. While this can mean numerous costly co-pays over time, it may be the only option. A patient may not be able to find a migraine surgeon, or one who accepts their insurance. Each insurance plan is vastly different and patients must check with their insurer about eligibility for such benefits.Catherine Hannan, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Is cosmetic surgery the Hail Mary play the chronic migraine community has been longing for?
In selected patients who have failed traditional migraine therapy, it is certainly a safe and effective treatment with minimal downtime and few complications. A neurologist who is a migraine specialist can help evaluate and determine if a patient is a good candidate.Catherine Hannan, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.