American Headache Society

View all recommendations from this society

Released November 21, 2013

Don’t recommend surgical deactivation of migraine trigger  points outside of a clinical trial.

The value of this form of “migraine surgery” is still a research question. Observational studies and a small controlled trial suggest possible benefit. However, large multicenter, randomized controlled trials with long-term follow-up are needed to provide accurate estimates of the effectiveness and harms of surgery. Long-term side effects are unknown but potentially a concern.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Headache Society (AHS) Board of Directors approved the creation of a task force to lead work on the Choosing Wisely® campaign. The task force consisted of: Elizabeth Loder, MD, MPH, (AHS President), Stephen Silberstein, MD, (Chair of the AHS Guidelines and Position Paper Committee), Randolph Evans, MD, Benjamin Frishberg, MD, Scott Litin, MD, Donald Dworek, MD, Josif Stakic, MD, and Jessica Ailani, MD.

The list was developed in consultation with AHS members, who received an electronic survey informing them of the project and asking them to recommend items to be considered for the list. The task force reviewed a list of 11 candidate topics that had been developed from the over 100 suggestions received from AHS members.

The task force met twice by conference call to review the suggestions and choose items for further development, and then communicated electronically during the development and approval process. Final items were selected based on commonly encountered situations in headache medicine associated with poor patient outcomes, low-value care or misuse or overuse of resources. The five recommendations were then approved by the AHS Executive Committee and Board of Directors.

The AHS disclosure and conflict of interest policy can be found at:


Guyuron B, Kriegler JS, Davis J, Amini SB. Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg. 2005;115:1–9.

Guyuron B, Reed D, Kriegler JS, Davis J, Pashmini N, Amini S. A placebo-controlled surgical trial of the treatment of migraine headaches. Plast Reconstr Surg. 2009;124:461–8.

Guyuron B, Kriegler JS, Davis J, Amini SB. Five-year outcome of surgical treatment of migraine headaches. Plast Reconstr Surg. 2011;127:603–8.

American Headache Society urges caution in using any surgical intervention in migraine treatment. Position statement of the American Headache Society [Internet]. Mount Royal (NJ): American Headache Society; 2012 April 13 [cited11 January 2013] Available from: