Despite an incomplete understanding of the pathophysiology of migraine headache pain, there have been recent discoveries in neurobiology and craniofacial anatomy that suggest a peripheral nerve trigger point mechanism. The current mainstay of treatment for migraine headache is a combination of abortive and preventative medication. However, properly selected migraineurs with debilitating pain refractory to pharmacologic therapy may find substantial relief through surgical deactivation of peripheral nerve trigger sites. This chapter reviews accepted migraine diagnostic criteria, explains contemporary theories of migraine physiology, and discusses the evidence and rationale for the medical and surgical management of migraine headache pain.