Introduction The transpalpebral resection of the corrugator muscles is a novel approach of treating migraine which is based on the decompression of selective branches of the trigeminal nerve. In contrast to the traditional, conservative therapy with expensive acute medication which does not alter the character and frequency of the migraine attacks, the surgical intervention is a single procedure with lasting effects. 12%-15% of the population in the western world suffer from migraine entailing billions of costs per year in terms of medication, loss of work power and consequences of chronic abuse of analgesics. This study compared the direct and indirect costs of 70 patients during one year prior to the specific migraine surgery with the expenditures of the same time period one year postoperatively. Material and Methods The corrugator muscles were chemically denervated with Botox® in 92 migraine patients after the identification of individual trigger points. 74 of these 90 patients experienced a significant symptomatic improvement. The surgical resection of the respective structures was performed on 70 of them. Data were collected retrospectively about the number and specialties of physicians consulted, diagnostic means, forms of treatment including triptans and prophylaxis, prescription-free medication, alternative regimen and individual sick-leave for a time period of one year. The same set of information was assembled prospectively for one year following the operation. Results The average, cumulative cost of each migraineur was 6524 € in the year prior to surgery. The combination of direct and indirect cost in the postoperative year was 395 € per patient. 86% of the patients reported a significant and lasting improvement at the one-year follow-up. The number of days off work decreased by 91 %, thus diminishing the public economic burden by 95%. The consumption of triptans was reduced by 84 %. The individual costs, not covered by health care, decreased by 87%. The cost of the operation is 3462 €. Conclusions Migraine patients who are suitable for the surgical treatment are not a representative sample. The operation is preceded by several months of tests and documentation. The patient selection is of crucial importance for the efficacy of the surgical intervention. In this particular sub-group the cost-effectiveness of the surgical treatment is clearly superior to conservative therapies which is reflected by the increasing willingness of german insurance companies to cover the one-time costs of the operation.