Surgical techniques may help alleviate migraines, research suggests

In the Los Angeles Times (7/31) Booster Shots blog, Shara Yurkiewicz noted that “patients with frequent moderate to severe migraine headaches with pain radiating from a single region were treated surgically — with excellent results.” Researchers at Case Western Reserve University explained that “Botox [botulinum toxin type A] injections to the forehead, neck, or shoulders have already been shown to help some people who suffer from migraines, possibly by relaxing key muscles. But the pain eventually comes back.”

Last week, however, “American cosmetic surgeon Bahman Guyuron, MD, revealed that he has devised a one-hour operation which has worked on 90 percent of his patients who suffer from migraines, with many of them having no further symptoms after five years,” the UK’s Daily Mail (8/1, Hartley) reported. “He discovered that the removal of the frown muscle, or corrugator supercilii, which sits above the eyebrow on the forehead, seemed to cure migraines.” Dr. Guyuron attributes his success to the belief he has that “many migraines are caused through tension, and by nerves in the face, neck, or scalp being irritated by over-tight muscles.”

Dr. Guyuron and his team tested that hypothesis on 75 patients, according to HealthDay (7/31, Gardner). In their paper published in Plastic and Reconstructive Surgery, the team explained that “migraine trigger sites in the forehead, cheek, and back of the head/neck were identified, then injected with the face-lifter Botox to see if the drug ‘disarmed’ them.” And, if “the trigger sites responded to the Botox, which lasts about six-to-eight weeks, then the patients underwent surgery to remove the trigger areas.” In all, 49 “patients were randomized to receive ‘real’ surgery and 26 to ‘sham surgery,” with the procedures varying by trigger points. For “the patients with forehead headaches, we removed the frowning muscles,” while those “with temple headaches underwent an operation on a small nerve, which also lifted their eyebrows.” For participants “with a back-of-the-head trigger, Guyuron replaced a small amount of muscle around the occipital nerve with fatty tissue to shield the nerve from being squeezed by the muscle.”

A year later, “83 percent of the actual surgery group reported at least a 50 percent reduction in migraines, compared to 57 percent of the sham surgery group,” WebMD (7/31, Boyles) reported. “Even more surprising, 57 percent of actual surgery patients reported complete elimination of migraines, compared to just four percent of sham surgery patients.” Dr. Guyuron was quick to point out, however, that “surgery is not a good option for patients who have infrequent migraines and those who respond to preventive treatments.”

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