Published Jan 1, 2024
8 minute read
For Bergen County patients who have spent years cycling through medications, Botox, and lifestyle changes without lasting relief, migraine surgery offers a fundamentally different path forward. Beginning August 2026, The Breslow Center for Plastic Surgery will offer nerve decompression migraine surgery to patients across Northern New Jersey and the greater New York metro area — performed by board-certified plastic surgeon Dr. Gary D. Breslow.
This outpatient procedure addresses the anatomical sources of chronic migraines rather than masking the symptoms. For the right candidate, the results can be life-changing.
Schedule a Consultation · Call (201) 444-9522.
Migraine surgery — also called nerve decompression surgery — is a procedure pioneered by plastic surgeons after a remarkable clinical discovery: patients undergoing cosmetic forehead lifts often reported their chronic migraines disappeared. Researchers traced the relief to the release of peripheral nerves that had been chronically compressed by surrounding muscle, fascia, or blood vessels.
By identifying these compression points — called trigger sites — and surgically releasing the pressure on the affected nerves, surgeons can interrupt the cascade that generates migraine pain at its source. The American Society of Plastic Surgeons recognizes nerve decompression as an established treatment for select chronic migraine patients.
This is not brain surgery. It is precise, anatomically focused work on the peripheral nerves of the head and neck — the kind of microsurgical work plastic surgeons are uniquely trained to perform.
Migraines often originate at one or more of the following trigger sites. The specific procedure depends on which nerves are involved in your pain pattern:
Frontal trigger site. Decompression of the supraorbital and supratrochlear nerves above the eyes. Often associated with pain that begins in the forehead or at the eyebrow.
Temporal trigger site. Release of the zygomaticotemporal nerve at the temple. Often associated with pain radiating from the temples.
Occipital trigger site. Occipital nerve decompression addresses the greater and lesser occipital nerves at the back of the head and upper neck. Often associated with pain starting at the base of the skull.
Nasal trigger site. Treatment of contact points inside the nasal cavity that can refer pain to the head or behind the eyes.
Auriculotemporal trigger site. Decompression near the temple and ear, often associated with side-of-head pain.
Patients may have one or multiple dominant trigger sites, and identifying all clinically relevant sites is critical to surgical success.
Migraine surgery is best suited for patients who:
The Botox response matters enormously. If targeted Botox injections temporarily reduce or eliminate migraines at a specific site, surgical decompression of that same site is far more likely to succeed. The Breslow Center’s experienced injectors at our on-site Injxcellence Medical Spa make us well-equipped to handle this diagnostic step in-house when needed.
Consultation. Your first visit at our Paramus office includes a thorough review of your migraine history, prior treatments, and pain patterns. We coordinate with your neurologist whenever possible.
Trigger site mapping. Diagnostic Botox is typically used before surgery to confirm which trigger sites are driving your migraines. This step is essential — we will not recommend surgery until we have strong evidence it will help you.
The procedure. Migraine surgery is performed on an outpatient basis under general or local anesthesia, depending on how many trigger sites are addressed. Most procedures take one to three hours. You go home the same day.
Incisions. Small and discreetly placed — typically within the hairline, eyelid creases, or natural skin folds — so visible scarring is minimal.
Most patients return to desk work within one week and resume full activity within two to three weeks. Some swelling, numbness, or tightness in the treated areas is normal in the early weeks and resolves over the following months.
Migraine relief itself often appears gradually. Many patients notice improvement within the first few weeks; full results typically stabilize three to six months after surgery as the decompressed nerves fully recover.
Published outcomes from peer-reviewed studies of migraine surgery are encouraging. A majority of well-selected patients experience a significant reduction in migraine frequency, intensity, or duration. A meaningful share report complete elimination of their migraines.
The candor we owe you: surgery is not a guaranteed cure, and outcomes depend heavily on accurate trigger site identification and patient selection. We will be straightforward with you about whether you are a strong candidate. If you are not, we will tell you so.
Migraine surgery cost varies based on the number of trigger sites treated, anesthesia, and facility fees. We provide transparent, written cost estimates after your consultation.
Insurance coverage for migraine surgery is improving but remains inconsistent. Some carriers cover the procedure when criteria are met (failed conservative treatments, documented chronic migraine diagnosis, positive diagnostic Botox response). Our team will work with you to determine your benefits and pursue prior authorization where appropriate.
Migraine surgery sits at the intersection of plastic surgery and headache medicine. It demands precise anatomical knowledge of the peripheral nerves of the head and neck — the same knowledge that underlies microvascular reconstructive surgery.
Dr. Gary D. Breslow is board-certified by the American Board of Plastic Surgery, a Fellow of the American College of Surgeons, and a member of the American Society of Plastic Surgeons. He completed fellowship training in microvascular reconstructive surgery at NYU and plastic surgery at the Hospital of the University of Pennsylvania — backgrounds that translate directly to the precision required for nerve decompression work. He has practiced in Paramus for more than 20 years and is licensed in both New Jersey and New York.
The Breslow Center has been a trusted name in Bergen County plastic surgery since its founding, with thousands of procedures performed and a reputation built on natural, lasting results.
Located at One West Ridgewood Avenue in Paramus, The Breslow Center serves migraine patients from across Northern New Jersey and the greater NYC area, including Ridgewood, Wyckoff, Ho-Ho-Kus, Glen Rock, Fair Lawn, Hackensack, Englewood, Tenafly, Fort Lee, and Bergen County more broadly. We also welcome patients traveling from Manhattan, Westchester, and Rockland County.
If you are living with chronic migraines and want to learn whether surgery could finally bring relief, we would be glad to meet with you.
The Breslow Center for Plastic Surgery & Medical Spa
1 W. Ridgewood Ave, Suite 110, Paramus, NJ, 07652
Phone: (201) 444-9522 Email: Info@breslowmd.com
Is there really a surgery for migraines?Yes. Migraine surgery — formally called peripheral nerve decompression — has been performed by plastic surgeons for more than two decades and is supported by a growing body of peer-reviewed clinical evidence. It is most effective for patients with chronic migraines that have not responded to medication and Botox.
What is considered a chronic migraine? The standard medical definition is 15 or more headache days per month for at least three months, with at least 8 of those days having migraine features. A neurologist makes the formal diagnosis.
How is migraine surgery different from Botox? Botox temporarily relaxes muscles that may be compressing nerves and must be repeated every three months. Migraine surgery permanently releases those compression points. A positive response to Botox at a specific trigger site is one of the strongest predictors of surgical success at that same site.
Will my insurance cover migraine surgery? It depends on your carrier and your documentation. Coverage is improving as the evidence base grows. We will help you investigate your benefits during the consultation process.
How long until I see results? Some patients notice improvement within weeks. Most see meaningful change by three months, with results stabilizing by six months as the nerves fully recover.
Where is The Breslow Center located? 1 W. Ridgewood Ave, Suite 110, Paramus, NJ, 07652 — easily accessible from Routes 4, 17, and the Garden State Parkway, with patients regularly traveling from across Bergen County, North Jersey, and New York City.
Migraine surgery is a medical procedure with risks and benefits that should be discussed in detail with a qualified surgeon. Individual results vary. This page is informational and does not constitute medical advice.
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