Migraine Surgery in Seattle & Bellevue
If you live with chronic migraine, you have likely cycled through medications, felt dismissed, and been told to manage what cannot be managed. Migraine surgery exists for exactly this population, and having exhausted other options does not disqualify you — it may make you the ideal candidate.
The operation decompresses the cranial nerves that trigger migraine at specific, identifiable sites. The American Society of Plastic Surgeons recognizes it as a valid reconstructive procedure, and published outcome studies report meaningful improvement in roughly seventy to eighty percent of properly selected patients, sustained at five years.
Medication manages symptoms. This operation addresses a structural cause: pressure on a nerve, at a site that can be found and released. That difference is the whole reason it exists.
Dr. Day is the only Migraine Surgery Society member in the Pacific Northwest, and consultations here run up to an hour, because proper selection is the entire game.
Your surgeon
Dr. Kristopher Day is certified by the American Board of Plastic Surgery and the American Board of Surgery, and is fellowship-trained in craniofacial surgery.
Meet Dr. DayThe operation
Every consultation — and every operation — is with Dr. Day.
Migraine surgery releases compressed nerves at the trigger sites your mapping identifies. The four primary zones are the forehead, the temple, the nose, and the back of the head; surgery addresses the site or sites driving your attacks, not every zone at once. At each site the surrounding muscle, fascia, or bone contact is released — and crossing blood vessels, a common culprit, are ligated — so the nerve fires without provocation.
The technique is called neurolysis: the nerve itself is not cut. It is freed. Whatever is pressing on it — a band of muscle, a tight fascial tunnel, a vessel crossing directly over it, a point of bony contact — is divided or moved aside, and the nerve is left intact in a decompressed bed. That distinction matters, because the goal is a nerve that works normally rather than a nerve that has been silenced.
Surgery is performed under general anesthesia at an accredited surgical facility and takes roughly one to four hours, depending on how many sites are treated. Incisions are small and placed inside the hairline or within natural creases, where they sit in the lines your face already has.
Candidacy is mapped before anyone operates: targeted neuromodulator injections at suspected trigger sites serve as the diagnostic. If quieting a site quiets your migraines, that response is the strongest evidence surgery at that site will help — a positive trial is the best predictor in the published literature.
The four trigger zones
Migraine surgery is not one operation. It is four, matched to where your attacks actually begin — which is why mapping comes before any incision. Most patients recognize their own pattern in one or two of these.
Frontal — the forehead and brow
The supraorbital and supratrochlear nerves pass through the muscles that furrow the brow. Pain that starts above the eye or behind it, often with brow tension, points here. Release frees the nerve from the surrounding muscle and any vessel crossing it.
Temporal — the temple
The zygomaticotemporal branch of the trigeminal nerve runs through the temporalis fascia. Attacks that begin at the temple, sometimes triggered by chewing or clenching, point here. The approach is through a small incision hidden in the hair.
Rhinogenic — inside the nose
When the septum contacts a turbinate, that contact point can trigger attacks — often with congestion, weather sensitivity, or pain felt behind the eyes. This zone is addressed from inside the nose, with no external incision.
Occipital — the back of the head
The greater and lesser occipital nerves pass through neck muscle and fascia on their way up the scalp. Pain that starts at the base of the skull and travels forward points here; a crossing vessel is a frequent finding and is ligated when present.
Is it right for you
The strongest candidates have a chronic migraine diagnosis from a neurologist, have genuinely tried conservative management, and can localize where attacks begin. A positive response to targeted injection mapping seals the case.
The mapping itself is straightforward. Your history comes first: where attacks start, what sets them off, what the pain does as it builds — a pattern that usually points at one or two zones before anyone touches you. Examination checks those zones for tenderness and for the anatomy that tends to compress a nerve. Then a targeted neuromodulator injection quiets the suspected site or sites. If your migraines quiet with it, that site is implicated; if nothing changes, that site probably is not the driver, and surgery there would not help. Prior neuromodulator treatment counts as evidence too — Dr. Day reads your existing history rather than repeating work you have already done.
A neurologist stays part of this. Migraine surgery does not replace neurological care, and the diagnosis, the medication history, and the ongoing management belong with the physician who has been treating you. Where records are available, they shorten the evaluation considerably.
This is not first-line treatment and is never sold as one. It is an option for the properly selected minority whose migraines are driven by compressible trigger sites — and the hour-long consultation exists to find out honestly whether that is you. Patients whose attacks do not localize, or who have shown no response to targeted injections at any site, are usually told directly that surgery is not the right tool, which is a better answer than an operation that was never going to work.
Recovery
Most patients are surprised by how manageable recovery is. Walking is encouraged starting the day after surgery, and most patients return to desk work within the first week. Temporary numbness or tingling at the release sites is expected and resolves over weeks to months.
Exercise builds from weeks two to four, with full activity at four to six weeks. Migraine improvement typically declares itself over the following months as the nerves settle.
One honest note about the early weeks: a decompressed nerve can be noisy while it recovers, so some patients feel odd sensations — numbness, tingling, occasional zings — around the incisions before things quiet down. That is nerve healing, not failure, and it is why the real read on your result comes at months rather than days.
How the weeks before and after surgery fit together is covered in the practice's recovery guide.
Why a plastic surgeon performs this operation
The question comes up in nearly every consultation, and it has a real answer.
Migraine surgery was pioneered by plastic surgeons. Patients who had brow and forehead procedures kept reporting that their migraines had eased or stopped, the specialty investigated why, and the mechanism turned out to be decompression of the cranial nerves those operations happen to pass. What began as an observation became a studied procedure with published outcomes behind it.
The trigger sites sit in the anatomy plastic surgeons work in every day — the forehead and brow, the temple, the nose, the back of the scalp and neck. Dr. Day's craniofacial fellowship is subspecialty training in exactly that territory: the nerves, vessels, muscle, and bone of the head and face. He is also the only Migraine Surgery Society member in the Pacific Northwest.
Neurologists diagnose and manage migraine; they do not operate. The two roles are complementary rather than competing, and the best outcomes here come from patients who have both.
Patient Voices
Individual results vary. Quotes are verbatim excerpts from reviews published by patients.
“I've always heard plastic surgeons are egotistical, but Dr. Day wasn't like that. … At my in-person consultation, he spent an hour and a half listening to my entire migraine history.”
“He asked me to describe and point to my pain, and after discussing the risks, we scheduled surgery to target four different nerves in my temples (where the pain was located). … This surgery is likely not for everyone and for every type of headache, and Dr. Day told me that he turns down folks who are not good candidates.”
Questions, answered
The rest belong in a conversation. Consultations are unhurried by design.
Is migraine surgery legitimate?
Yes. The American Society of Plastic Surgeons recognizes nerve decompression as a valid reconstructive procedure, and a substantial peer-reviewed literature supports it — including five-year outcome data. Skepticism is reasonable; the evidence answers it.
What is the success rate?
Published outcome studies report meaningful improvement — fewer, shorter, or less severe attacks, and sometimes elimination — in roughly seventy to eighty percent of properly selected patients, with results sustained at five years or more. Selection is the operative phrase, and it is taken seriously here.
Why would a plastic surgeon treat migraines?
Migraine surgery was pioneered by plastic surgeons: patients who had forehead lifts reported their migraines vanished, and the specialty traced why. The trigger sites live in the head-and-face anatomy plastic surgeons access daily — anatomy that Dr. Day's craniofacial fellowship training studies at the subspecialty level — and he is the only Migraine Surgery Society member in the Pacific Northwest.
What does a positive injection response mean?
That your migraines quiet when a specific trigger site is quieted — the strongest available evidence that decompressing that site surgically will help. It converts guesswork into a mapped plan.
What exactly is a trigger site?
A specific point where a cranial nerve is compressed — by muscle, by fascia, by a crossing blood vessel, or by contact inside the nose. There are four primary zones: the forehead and brow, the temple, inside the nose, and the back of the head. Your attacks usually implicate one or two, and the pattern of where your pain begins is the first clue to which.
Is the nerve cut or removed?
Neither. The nerve is freed — whatever presses on it is divided or moved aside, and the nerve is left intact. The aim is a nerve that behaves normally rather than one that has been silenced, which is why the operation is called decompression.
What if only part of my migraines improve?
It happens, and it is usually informative rather than disappointing. When one site is treated and the improvement is partial, another trigger site is often driving what remains, and it can be evaluated and addressed separately. Results vary with how many sites are involved and whether all of them have been identified.
Could I go from chronic migraines to occasional ones?
That is a common shape for a good result. Chronic migraine is defined clinically as fifteen or more headache days a month; published outcome studies describe many properly selected patients moving out of that pattern into far fewer migraine days, and some patients stop having them. Complete elimination happens, but improvement — fewer, shorter, or less severe attacks — is the more typical outcome.
How do I know whether I'm a candidate?
The consultation is built to answer exactly that. Dr. Day reviews your full migraine history, examines the suspected zones, reads your prior injection response if you have one, and tells you plainly whether surgery is likely to help. If it is not, you will hear that — it is the more useful answer.
Will insurance cover it?
Sometimes, with a medical-necessity case: diagnosis, failed conservative treatment, and the injection response. The office assists with pre-authorization and appeals, and tells you honestly what your plan is likely to do.
I've failed every migraine treatment. Am I still a candidate?
Possibly the best kind. Surgery targets a mechanical cause medications cannot reach, so a long list of failed treatments does not disqualify you — for properly selected patients, it is part of the indication.
How much does migraine surgery cost?
Migraine surgery starts from $9,500, with the total following the number of trigger sites treated, quoted in writing at consultation. When insurance declines, CareCredit and Alphaeon financing are available.
Financing Options