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Surgery Doubted as a Migraine Reliever

Review of two studies finds inconclusive evidence of success

WebMD News from HealthDay

By Amy Norton

HealthDay Reporter

FRIDAY, June 27, 2014 (HealthDay News) -- Migraine surgery is increasingly touted as a potential "cure" for the debilitating headaches, but researchers say the evidence just isn't there to support those claims.

In an analysis of two studies on migraine trigger "deactivation" surgery, researchers found multiple flaws in the study methods. What's more, they say, the surgery carries risks and high costs not covered by insurance, and doesn't jibe with what's known about the underlying causes of migraine.

"The surgery is, first of all, unproven. Second, permanent side effects are not uncommon," said Dr. Paul Mathew, a neurologist and headache specialist at Brigham and Women's Hospital in Boston.

Those lingering problems include persistent itching and numbness in areas affected by the surgery -- which is typically offered by plastic surgeons, not headache specialists.

Mathew, who led the research analysis, was scheduled to present his findings this week at the American Headache Society's annual meeting in Los Angeles. Until published in a peer-reviewed journal, the findings should be considered preliminary.

Around 10 percent of the world's population complains of migraines, according to the U.S. National Institutes of Health. Migraines typically cause intense, throbbing pain on one side of the head, along with sensitivity to light and sound, and sometimes nausea and vomiting.

Generally speaking, headache specialists are skeptical of migraine surgery, which also goes by terms such as "nerve decompression" and "trigger point release." The approach was pioneered more than a decade ago by an Ohio plastic surgeon, Dr. Bahman Guyuron, after he found that some patients who had facial "rejuvenation" procedures reported a side effect: relief from migraines.

Since then, plastic surgeons have developed a few approaches to migraine surgery, depending on where they determine the "trigger" to be. The surgeon might remove portions of muscle in the forehead or back of the neck; tissue inside the nose, or a segment of the trigeminal nerve -- one of the nerves running from the brain to the face and mouth.

Increasingly, centers offering migraine surgery are popping up across the United States, with some marketing it as a "cure," Mathew said.

A few small studies reported in plastic surgery journals have found that a majority of patients report pain relief after migraine surgery. But the research contains too many flaws to judge its true effectiveness, Mathew said.

The two studies he analyzed are the largest and most widely cited. One involved 75 patients, with 49 receiving surgery and the rest undergoing "sham" surgery; the other followed 79 patients for five years after surgery.

The success rates appeared high. In the first study, 84 percent of surgery patients reported a 50 percent reduction in their migraines. But so did 58 percent of those who underwent the phony procedure.

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