Am I a Candidate for Migraine Surgery? A Miami Plastic Surgeon's Checklist

You may be a candidate for migraine surgery in Miami if a neurologist has diagnosed your migraines, your attacks stay frequent despite preventive medication, and your pain consistently starts in the same spot. Patients who got temporary relief from Botox or nerve blocks at that spot are often the strongest candidates. At Revive Surgical Institute, Dr. Morad Askari confirms candidacy at an in-person consultation and recommends migraine surgery only when the evidence points to a good chance of meaningful relief.

Below is the checklist Dr. Askari works through, and what each item tells him.

1. A Confirmed Migraine Diagnosis From a Neurologist

Migraine surgery treats migraines, not every kind of headache. Tension headaches, cluster headaches and headaches caused by other conditions behave differently and need different care. That is why the first requirement is a diagnosis from a neurologist who has ruled out other causes.

If you have not seen a neurologist yet, that is the place to start. Dr. Askari works alongside your neurologist before and after surgery, and the surgery is one part of your overall migraine care rather than a replacement for it.

2. Frequent, Disabling Attacks Despite Treatment

Good candidates have migraines that still take over many days a month after they have tried standard treatment. That usually means preventive medications, rescue medications and often Botox injections prescribed by a neurologist.

Some patients are candidates because medication does not work for them. Others are candidates because they cannot tolerate the side effects, such as fatigue, weight change or brain fog. Both situations count. What matters is that migraines still disrupt work, family life and sleep.

3. Attacks That Start in the Same Spot

This is one of the strongest signs that surgery may help. Migraine surgery works by releasing small sensory nerves that are squeezed or irritated by muscle, blood vessels or tissue at specific trigger sites. If your attacks consistently begin above the eyes, at the temples, at the base of the skull or behind the eyes, that pattern points to a site Dr. Askari can treat.

A headache diary makes this pattern much easier to see. Note where each migraine starts, how long it lasts and how severe it gets. Patients whose pain starts in a different place every time, or spreads across the whole head from the first minute, are harder to match to a trigger site.

Our guide to the 4 migraine trigger sites explains what each one feels like and how surgery treats it.

4. Relief From Botox or Nerve Blocks

A good response to Botox injections or a nerve block at a specific spot is useful evidence. Both treatments quiet the nerve or muscle at that site for a while. If your migraines ease after an injection at the forehead or the back of the head, that suggests the nerve at that site is involved in your attacks.

The relief from these treatments wears off, which is often why patients start looking into surgery. Surgery aims to address the same site with a lasting release rather than repeat injections. A patient who never responded to Botox or nerve blocks can still be evaluated, but the case for surgery is usually less clear.

5. Good General Health and Realistic Expectations

Migraine surgery is usually an outpatient procedure under general anesthesia, so you need to be healthy enough for anesthesia and for a short recovery. Dr. Askari reviews your medical history and current medications as part of that assessment.

Realistic expectations matter just as much. Migraine surgery is not a guaranteed cure. Most patients see a large improvement in how often migraines happen, how severe they are and how long they last, and a small percentage become migraine-free. Some improve less. A candidate understands that the goal is fewer, milder and shorter attacks, and that results build over months.

Who Is Usually Not a Candidate

Surgery is usually not recommended for patients who:

• Have headaches that have not been diagnosed as migraines by a neurologist
• Have not tried standard preventive treatment yet
• Have migraines with no consistent starting point
• Have a medical condition that makes general anesthesia unsafe
• Expect surgery to end all migraines with certainty

Not being a candidate today does not mean never. A patient who keeps a headache diary for a few months or tries a nerve block with their neurologist may come back with the evidence that makes surgery a reasonable next step.

Why the Surgeon’s Assessment Matters

Patient selection is the biggest factor in how well migraine surgery works. Dr. Morad Askari, MD, MBA, FACS, is a board-certified plastic surgeon with more than 15 years of experience in reconstructive work on small nerves and vessels, including reconstructive hand surgery and microvascular reconstruction. He trained at the Mayo Clinic and the University of Southern California and served as an Associate Professor at the University of Miami.

He gives every migraine patient an honest assessment. If surgery is unlikely to help you, he will tell you directly, and he will explain what evidence would change that answer.

Conclusion

You are most likely a candidate for migraine surgery if a neurologist has diagnosed your migraines, treatment has not controlled them, your attacks start in a consistent spot and Botox or nerve blocks at that spot gave you temporary relief. To find out where you stand, learn more about migraine surgery in Miami and book a consultation with Dr. Askari.