@Rbnwht - You have a couple of VERY LONG styloids! WOW! They are quite impressive! No wonder you’re having the problems you are. The neurologist likely recognized that your symptoms are coming from irritated cranial nerves & that’s probably why you were Rxed the meds. They may not help immediately as nerve pain meds can take several weeks to kick in. Your migraines are likely related to some vascular compression you’re experiencing from ES. They should subside when the styloids are gone.
As far as surgery goes, we recommend external surgery over intraoral because the nerves & vascular tissues can be monitored during surgery, & there is better access to the styloids & stylo-hyoid ligaments so they can be removed from skull base to hyoid bone which will give you the best results. There is also a lower rate of post op infection. The most experienced ES doctors require two surgeries for bilateral cases to help prevent complications from too much throat swelling.
As far as intraoral surgery goes, there are quite a number of forum members who’ve had successful intraoral surgeries but also a number who had to have follow-up surgeries because not enough of the styloid was removed or the tip of the remaining styloid wasn’t smoothed off & symptoms continued to be bad. There are new intraoral techniques that allow the styloid to be fully removed & the s-h ligaments as well, but this requires several incisions to be made in the throat. If the doctor you’re seeing is unwilling to consider external surgery, MAKE SURE that (s)he will be removing the styloid as close to the skull base as possible & smoothing off the tip of anything left behind. Merely shortening the styloid will not serve you well.
Many people choose to get a second opinion before having surgery. Dr Samji in CA & Dr. Cognetti in PA are both very experienced ES surgeons who do phone/video consults for a fee. Dr. Samji gives more priority to ES patients so the wait time for an appt w/ him is normally much shorter than for Dr. Cognetti.