Surgical treatment for migraine: Time to fight against the knife.

Migraine can be a disabling disease if migraine attacks are frequent and severe (1). Frequent migraine requires preventive therapy by drug treatment (2) in combination with counselling, behavioural therapy or exercise. As in all chronic diseases, patients are inclined to search for the ultimate treatment that supposedly cures the condition. Here comes the attraction of surgical or interventional therapy. Patients with poor understanding of the complex pathophysiology of migraine tend to believe that surgical or interventional procedures might be effective in migraine with only minor or no longterm adverse events and fail to apply the necessary lifestyle modifications. In this editorial we will briefly discuss the missing evidence for the surgical treatment of trigger sites, chronic bilateral occipital nerve stimulation (ONS) and patent foramen ovale (PFO) closure and discuss the impact of the placebo effect in studies with surgical interventions.