BACKGROUND Migraine headache is a widespread neurovascular disorder that is often suboptimally or incompletely treated. This article confirms the efficacy of botulinum toxin treatment with surgical decompression as a deactivator of migraine headache trigger sites through the retrospective analysis of a single surgeon's experience. METHODS A retrospective chart review was performed on 24 patients presenting with the diagnosis of migraine headache. Botulinum toxin type A injections were used to identify frontal, temporal, and/or occipital trigger points. The nasal trigger point was diagnosed with a decongestant trial, intranasal examination, and computed tomographic scan. Those patients with more than one trigger point underwent multiple surgical procedures, which were performed concomitantly during the same operation. All botulinum toxin injections, surgical procedures, and patient meetings were conducted by the principal investigator (J.E.J.), minimizing intrapatient treatment variability and multiprovider bias. RESULTS Patient progress was tracked by consolidating migraine frequency, severity, and duration as a Migraine Headache Index. Nineteen patients (79.2 percent) benefited from surgery. Two patients (8.3 percent) reported migraine elimination and 17 patients (70.8 percent) reported significant improvement of their migraine symptoms. Among those patients who responded to surgery, average improvement from baseline levels was 96.9 percent. Among the entire patient population, average improvement was 78.2 percent from baseline. The mean postsurgical follow-up was 661 days. CONCLUSION This study found botulinum toxin treatment with surgical decompression to be a potent deactivator of migraine headache trigger sites, corroborating the findings of the current literature in the field and underlining the reproducibility of the treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE : Therapeutic, IV.(Figure is included in full-text article.).