WebMD Medical News
Laura J. Martin, MD
Feb. 3, 2011 -- A surgical technique that has evolved from a cosmetic procedure that smoothes forehead wrinkles may offer lasting relief from frequent or severe migraine headaches, a new study shows.
The study followed 69 patients after they had surgery to deactivate muscle and nerve trigger points in places like the forehead, temple, nose, and back of the neck.
After five years, surgeons reported that 88% of study participants had less frequent or severe migraines.
Nearly 60% of patients reported that their headaches were significantly better five years after the surgery, and 29% said their migraines were eliminated completely.
The study is published in the February issue of Plastic and Reconstructive Surgery.
“They did a five-year follow-up study, which is quite remarkable that they were able to do that long of follow-up, and found benefit in a significant amount of people,” says Robert Duarte, MD, a neurologist who is director of the pain and headache treatment center at Long Island Jewish Hospital.
“It will be interesting to see if other people can reproduce those results,” says Duarte, who was not involved in the study.
He also cautions that surgery should probably only be thought of as a last resort for most migraine patients since less invasive treatments have been proven to be effective for the debilitating headaches. Migraines may cause light sensitivity, nausea, chills, and intense pain.
“Surgery is not commonly recommended for treatment of migraine,” says F. Michael Cutrer, MD, assistant professor of neurology at the Mayo Clinic in Rochester, Minn., who was not involved in the study. “I do not recommend it at this point.”
The theory behind the surgery is that tiny nerves at the end branches of the larger trigeminal nerve, which carries pain signals and other sensations to the face and head, become irritated when they are rubbed or squeezed by muscles, connective tissue, or pressed against bone or blood vessels.
Study researcher Bahman Guyuron, MD, chairman of the department of plastic surgery at Case Western Reserve University, says he discovered the technique after patients on whom he’d performed brow lifts remarked that their migraine headaches had disappeared along with their wrinkles.
“Often when people have forehead migraine headaches, they have very strong frowning muscles,” Guyuron says.
In those patients, removing the corrugator muscle in the forehead area near the eyes, which may be irritating nerves in that area, may offer relief from recurrent headaches.
“He thought, well, maybe this is like carpal tunnel syndrome of the head instead of the hand,” says Jeffrey Janis, MD, a plastic surgeon and associate professor at the University of Texas Southwestern Medical Center in Dallas, who trained with Guyuron and also performs the surgery.
“You have nerves that are being irritated or compressed or entrapped by the muscle, and by taking away the muscle and it doesn’t grow back then maybe you’re decompressing it just the same as you would do in a carpal tunnel release,” Janis says.
Patients may also end up with fewer wrinkles. “For those patients, commonly the aesthetic outcome is pleasing. They just look like they’re less angry or are less serious,” Guyuron says.
Still, experts say surgery for migraines is probably only a good idea for patients who’ve tried less invasive measures first.
“The type of patients who usually are treated with this approach usually have very severe, difficult to control migraines,” Janis says. “They’ve seen a whole host of neurologists. They’ve tried a pharmacy full of medications, most of which have side effects that are undesirable. Most of my patients have also tried alternative forms of therapy like menthol patches, electrical stimulation, acupuncture.”
And he cautions that while the surgery does seem to help many patients who have it, it’s not foolproof.
“There is a failure rate to the surgery, so it doesn’t work in 100% of people and we don’t know exactly why yet,” he says.
SOURCES:Guyuron, B. Plastic and Reconstructive Surgery, February 2011.Bahman Guyuron, MD, chairman, department of plastic surgery, Case Western Reserve University.Jeffrey Janis, MD, associate professor, University of Texas Southwestern Medical Center, Dallas.Robert Duarte, MD, director, pain and headache treatment center, Long Island Jewish Hospital.News release, American Society of Plastic and Reconstructive Surgeons.F. Michael Cutrer, MD, neurologist, Mayo Clinic.
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