{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T13:27:13Z","timestamp":1778678833540,"version":"3.51.4"},"reference-count":309,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Migraine is a prevalent and disabling neurological disorder with multifactorial origins and complex clinical manifestations. While pharmacologic therapies remain the cornerstone of management, a growing body of evidence highlights the role of extracranial peripheral nerve compression as a significant contributor to migraine pathophysiology in selected patients. This recognition has expanded the therapeutic role of plastic surgery, offering anatomically targeted interventions that complement or surpass traditional medical approaches for refractory cases. From a plastic surgeon\u2019s perspective, optimal migraine care begins with accurate identification of clinical patterns, trigger-site mapping, and the judicious use of diagnostic tools such as nerve blocks and botulinum toxin. Surgical decompression techniques, including endoscopic and open approaches, address compression of the supraorbital, supratrochlear, zygomaticotemporal, greater and lesser occipital, auriculotemporal, and intranasal contact-point trigger sites. Adjunctive strategies such as autologous fat grafting further enhance outcomes by providing neuroprotective cushioning and modulating local inflammation through adipose-derived stem cell activity. Recent advances, including neuromodulation technologies, next-generation biologics, and innovations in surgical visualization, underscore the ongoing shift toward precision-based, mechanism-driven therapy. As understanding of migraine heterogeneity deepens, the integration of surgical expertise with modern neuroscience offers a comprehensive and personalized therapeutic framework. Plastic surgeons, equipped with detailed knowledge of peripheral nerve anatomy and minimally invasive techniques, play an increasingly pivotal role in the multidisciplinary management of refractory migraine.<\/jats:p>","DOI":"10.3390\/medicina62010050","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T06:25:51Z","timestamp":1766989551000},"page":"50","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Integrative Migraine Therapy: From Current Concepts to Future Directions\u2014A Plastic Surgeon\u2019s Perspective"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0965-9736","authenticated-orcid":false,"given":"Cristian-Sorin","family":"Hariga","sequence":"first","affiliation":[{"name":"Department 11, Discipline Plastic and Reconstructive Surgery, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7205-1134","authenticated-orcid":false,"given":"Eliza-Maria","family":"Bordeanu-Diaconescu","sequence":"additional","affiliation":[{"name":"Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5348-7213","authenticated-orcid":false,"given":"Andrei","family":"Cretu","sequence":"additional","affiliation":[{"name":"Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dragos-Constantin","family":"Lunca","sequence":"additional","affiliation":[{"name":"Department 1, Discipline Pharmacology, Clinical Pharmacology and Pharmacotherapy, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Ophthalmology Clinic, Central Military Emergency University Hospital \u2018Carol Davila\u2019, 010242 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catalina-Stefania","family":"Dumitru","sequence":"additional","affiliation":[{"name":"Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian-Vladimir","family":"Vancea","sequence":"additional","affiliation":[{"name":"Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9297-6769","authenticated-orcid":false,"given":"Florin-Vlad","family":"Hodea","sequence":"additional","affiliation":[{"name":"Department 11, Discipline Plastic and Reconstructive Surgery, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7843-0901","authenticated-orcid":false,"given":"Stefan","family":"Cacior","sequence":"additional","affiliation":[{"name":"Department 11, Discipline Plastic and Reconstructive Surgery, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladut-Alin","family":"Ratoiu","sequence":"additional","affiliation":[{"name":"Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2943-2611","authenticated-orcid":false,"given":"Andreea","family":"Grosu-Bularda","sequence":"additional","affiliation":[{"name":"Department 11, Discipline Plastic and Reconstructive Surgery, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6619","DOI":"10.1523\/JNEUROSCI.0373-15.2015","article-title":"Migraine: Multiple processes, complex pathophysiology","volume":"35","author":"Burstein","year":"2015","journal-title":"J. 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