Controversial Migraine Surgery Faces Scrutiny from Neurological Experts
More than 5 million people in Spain suffer from migraine, with over 70% experiencing severe disability and another 14% with moderate impairment. As the prevalence of this debilitating condition rises, so too does the search for effective solutions – including a growing, yet scientifically unsupported, trend toward surgical intervention.
The surgery, known as “peripheral nerve decompression surgery,” emerged almost two decades ago from the operating room of American plastic surgeon Bahman Guyuron. He observed that some patients undergoing blepharoplasty, a cosmetic eyelid procedure, reported a surprising side effect: the disappearance of their migraines. This observation sparked an investigation into a potential link between compressed facial nerves and the onset of migraine attacks.
In Spain, the procedure has gained traction in private plastic surgery clinics, promising relief to migraine sufferers. Its reach is even extending into the public healthcare system, raising concerns among leading neurologists. However, according to a report by El Confidencial, “no scientific institution in the world supports any of these surgical techniques that a small sector of plastic surgery performs for migraines,” stated Dr. Robert Belvis, Coordinator of the Spanish Neurology Society (SEN) Headache Study Group.
The core of the controversy lies in the surgery’s foundational premise: that migraine, a complex brain disease, is caused by the compression of small facial nerves by superficial arteries. The theory suggests that releasing these compressions through incision could alleviate pain. However, Dr. Belvis argues there is no pathophysiological evidence to support this claim. “It has never been shown that in migraine there is compressed nerves by arteries or injuries of that type,” he explained. “We have specific tests that would have detected it if that were the case, and they don’t.”
Furthermore, the surgery targets branches of the trigeminal nerve, while migraine pain typically manifests in the forehead, cranial vault, or back of the head – areas served by the occipital nerves, not the trigeminal nerve.
Neurologists also point to the natural course of migraine as evidence against the surgical approach. “Migraine tends to improve with age and often disappears after age 65, while diseases that do involve nerve compression worsen over time,” Dr. Belvis noted. He emphasized that the theory lacks a solid biological basis, stating, “We are facing a theory without physiopathological basis for one disease that we know is cerebral. Migraine is caused by an alteration in brain habituation to stimuli… What does that have to do with a compressed nerve? Absolutely nothing.”
The SEN has been voicing its concerns for a decade, repeatedly emphasizing the lack of scientific backing for the surgery. They regret that despite ongoing warnings, no new studies have emerged to provide robust scientific evidence supporting the procedure. The society advises patients considering this surgery to first consult with a neurologist, recommending it only within the context of research authorized by an accredited Research Ethics Committee.
Notably, the SEN highlights the absence of animal studies prior to human trials, a critical step in standard medical research. “It is serious that in this surgery the experimental phase in animals has been completely omitted, an essential step in any medical research,” a SEN representative insisted.
The skepticism extends to anecdotal evidence presented by proponents of the surgery. An example cited by Dr. Belvis involved an Austrian surgeon presenting video testimonials from two patients. “But, honestly, that cannot be considered scientific evidence. Having two patients say that they are better after surgery proves nothing.”
The SEN stresses that any surgery should meet the same rigorous standards of evidence as pharmaceutical treatments, including controlled clinical trials reviewed by ethical committees and involving headache neurologists. To date, published studies have failed to meet these criteria, lacking comparison to placebo or established pharmacological treatments.
The call for rigorous clinical trials, approved by regulatory agencies and supervised by expert neurologists, echoes concerns raised by American neurologists who also question the surgery’s lack of “sense and pathophysiological foundation.”
Ultimately, the SEN’s position is clear: the current evidence does not support surgical intervention for migraine. They urge caution and emphasize the importance of evidence-based treatment approaches for this debilitating condition.
