As awareness of “migraine surgery” increases, I have often been confronted by the question of whether the nerves that are involved need to be cut for the procedure to be effective. The answer to this question is “sometimes”, but let me elaborate in the next few sentences. There generally seems to be two perspectives on how to deal with "smaller" sensory nerves, in other words those with relatively small areas of sensory distribution. One approach would postulate that cutting the nerve oftentimes leaves a small area of numbness which is easily tolerated or is not even appreciated by the patient and therefore is a relatively good trade-off for relief of pain. Another perspective is that if the nerve is viable as noted during surgery, then leaving it intact will hopefully allow good relief of pain and preservation of sensation. Each of these approaches has its advantages and its disadvantages. Cutting the nerve can lead to immediate relief, but often leaves a noticeable area of numbness. Leaving the nerve intact requires the nerve to heal, recover and/or regenerate from the compression/irritation which was present as the cause for the surgical procedure. This process often requires several months depending on the longevity and severity of the compression/irritation, but if successful should lead to decreased pain and a preservation of some degree of sensitivity. Both procedures carry a small risk that nerve recovery will not occur and pain may persist. In the case of a cut nerve, the proximal (upstream) nerve end may remain persistently sensitive thus leading to a "phantom limb" type of sensation despite numbness in the former area of distribution. In the case of a decompressed nerve, the nerve may not regenerate again leading to persistent discomfort. Moreover, both procedures carry a small risk of neuroma formation although I personally believe that this risk is slightly less when nerves are left intact as compared to when they are cut.