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Surgical decompression of various trigger sites has been shown by two authors to relieve migraine headaches. The purpose of this study was to evaluate the effectiveness of surgical decompression of multiple migraine trigger sites in a clinical practice setting, and to compare the results to those previously published.A retrospective, descriptive analysis was performed on 18 consecutive patients who had undergone various combinations of surgical decompression of the supraorbital, supratrochlear, and greater occipital nerves and zygomaticotemporal neurectomy performed by a single surgeon. All patients had been diagnosed with migraine headaches according to neurologic evaluation and had undergone identification of trigger sites by botulinum toxin type A injections.The number of migraines per month and the pain intensity of migraine headaches decreased significantly. Three patients (17 percent) had complete relief of their migraines, and 50 percent of patients (nine of 18) had at least a 75 percent reduction in the frequency, duration, or intensity of migraines. Thirty-nine percent of patients have discontinued all migraine medications. Mean follow-up was 16 months (range, 6 to 41 months) after surgery. One hundred percent of participants stated they would repeat the surgical procedure.This study confirms prior published results and supports the theory that peripheral nerve compression triggers a migraine cascade. The authors have verified a reduction in duration, intensity, and frequency of migraine headaches by surgical decompression of the supraorbital, supratrochlear, zygomaticotemporal, and greater occipital nerves. A significant amount of patient screening is required for proper patient selection and trigger site identification for surgical success.