Integrative Migraine Therapy: From Current Concepts to Future Directions-A Plastic Surgeon's Perspective.

Area of Science:

• Neurology
• Plastic Surgery
• Peripheral Nerve Surgery

Background:

• Migraine is a common neurological disorder with complex causes.
• Pharmacologic treatments are standard, but some patients have refractory migraines.
• Extracranial peripheral nerve compression is increasingly recognized as a factor in migraine.

Purpose of the Study:

• To highlight the role of plastic surgery in managing refractory migraines.
• To detail surgical approaches for peripheral nerve decompression in migraine patients.
• To emphasize the integration of surgical expertise with neuroscience for personalized migraine therapy.

Main Methods:

• Accurate identification of clinical patterns and trigger sites.
• Diagnostic nerve blocks and botulinum toxin injections.
• Surgical decompression of specific peripheral nerves (supraorbital, occipital, etc.) via endoscopic or open techniques.
• Adjunctive autologous fat grafting.

Main Results:

• Surgical decompression addresses specific trigger sites contributing to migraine.
• Autologous fat grafting provides neuroprotection and reduces inflammation.
• Integration of surgical interventions with neuromodulation and biologics advances precision therapy.

Conclusions:

• Plastic surgery provides targeted interventions for refractory migraines.
• Peripheral nerve decompression is a viable therapeutic option for selected patients.
• Multidisciplinary care combining plastic surgery and neuroscience offers personalized migraine management.