[Abstract] Objective To investigate the clinical effect of microsurgery in the treatment of refractory migraine. Methods: 34 cases of migraine were treated by microsurgery, including 20 cases of superficial temporal artery ligation and auriculotemporal nerve release, 11 cases of occipital nerve and occipital artery dissection, and 3 cases of pain point “isolation”. Results: 28 cases were completely healed, 6 cases were improved, and there were no complications. Conclusion Microsurgery is one of the methods to treat refractory migraine because it is effective, minimally invasive and safe. Migraine is a common condition with a reported prevalence of 7.7-18.7%. Most of the symptoms can be relieved by medication, but there are still a few cases that cannot be controlled by medication and become refractory to migraine due to the ineffectiveness of long-term repeated medical treatment and gradual aggravation, which affects life and work. These patients can be controlled or cured by surgical treatment “1”, and 4 cases were treated by microsurgery in our department with satisfactory results. Data and methods 1. Clinical data Case 1: Female, 65 years old, retired teacher. She had intermittent right-sided migraine for 30 years, with frequent exacerbation attacks for 12 years. Before the attack, she had irritability, insomnia, fear of light and inability to watch TV. After a period of time, she had pain from the right ear to the forehead and from the right occipital region to the top of the head, lightning-like, painful, moaning and shouting, and hammering her head against the bed. The pain can be relieved by painkillers at one time, but with the passage of time, the pain is difficult to be relieved by general painkillers and worsens one after another. The treatment with drugs, acupuncture and closure was not effective, and he was repeatedly hospitalized for several times. There were no special abnormal findings on CT and MRI of the head. The superficial temporal artery was seen to be angry and pulsating significantly during the attack, and the pain was significantly reduced after compression. Case 2: Female, 46 years old, worker. The pain was mainly in front of the ear screen and the top of the forehead, and the pain was relieved by compression of the superficial temporal artery. Case 3: Female, 41 years old, an accountant, had recurrent occipital headache for 14 years, accompanied by insomnia, depression and other neurotic manifestations. She was hospitalized for several times and treated as migraine and neurosis, and the pain was relieved by occipital nerve closure. Case 4, male, 52 years old, had limited headache in the left parieto-occipital area for more than 10 years. The pain was about 5.0×5.0 cm in size, and the pain was heavy at each attack without aura. At first, he took painkillers effectively, but later he took painkillers including tramadol, which could not stop the pain. The pain was relieved by applying pressure to the painful spot. The examination showed hair loss and rough skin in the painful area. All four cases in this group came to hospital when they had painful episodes. 2.Surgical methods 20 cases of superficial temporal artery ligation plus auriculotemporal nerve release, 11 cases of occipital artery and occipital nerve dissection, and 3 cases of painful area skin “isolation”. The surgery was performed under local or general anesthesia and under microscope. For frontotemporal migraine, a longitudinal incision was made along the anterior superficial temporal artery and the auriculotemporal nerve trunk, and the superficial temporal artery trunk was first subcutaneously free for 2.0-3.0 cm, clamped and severed for about 1.0 cm, and ligated with 4 wires at both ends. At the same time, the branches of the nerve are released from under the skin along the auriculotemporal nerve, and the skin is sutured after hemostasis. For parieto-occipital migraine, a transverse incision was made at the occipital nerve (the site of pain relief after compression) and the occipital artery and occipital nerve were found under the microscope. For localized parieto-occipital migraine, a circular skin incision was made under local anesthesia around the pain area to reach the capitellar tendon membrane, and the capitellar tendon membrane was free. The pain disappeared immediately after surgery in all 28 cases, and all were headache-free at the time of discharge. At 1 year and 3 months to 2 years of follow-up, 20 patients with parietal temporal migraine with superficial temporal artery ligation plus auriculotemporal nerve release had been migraine attack-free. Patients with occipitoparietal migraine had headache after 1 year, but it was milder than before and did not require hospitalization and pain medication. Patients with parieto-occipital limited migraine had headache from time to time after 5 months, but it was not limited and milder, and the pain could be relieved by taking general painkillers. Discussion Migraine is the most common vascular headache, and its pathogenesis is not completely clear so far. There are theories of vascular origin, neurogenic theory, trigeminal vascular reflex theory and local vascular nerve compression, which can be cured in most patients by vascular decompression (cutting) [2.3.4]. It is suggested that compression or pulsatile stimulation of abnormal vessels is associated with most refractory migraines. Regarding the surgical approach many scholars have used vascular dissection, nerve dissection or release. The surgical site can be made as auriculotemporal nerve point, greater occipital nerve point, and supraorbital nerve point incision according to the pain site. In our group, we adopted the method of circumferential scalp dissection and release and excision of diseased tissues for a case of localized migraine, which was designed to achieve pain relief by disconnecting the neurovascular around the painful site and making the painful site an isolated area, which was called “isolation surgery” by the author. According to the literature and the experience of our group, the treatment of migraine by microscopic technique is minimally invasive, safe and effective, and it is an alternative treatment method for patients with intractable migraine with severe symptoms that do not heal for a long time.