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    Surgery Doubted as a Migraine Reliever

    Review of two studies finds inconclusive evidence of success

    continued...

    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.

    More important, Mathew found, it was unclear how patients were selected for surgery, or whether they were using migraine medications before or after the procedure. The studies also measured treatment "success" in ways that aren't standard for headache research.

    "It's an invasive procedure that has risks, it's expensive, and it's unproven," said Dr. Audrey Halpern, a headache specialist at NYU Langone Medical Center in New York City. "On its face, we should be skeptical."

    Plus, the approach does not fit with the biology of migraine, Halpern and Mathew said.

    Researchers have found that migraine is a gene-related disorder that involves dysfunction in the brain. People who suffer migraines can have various "triggers" that set off an attack -- such as disrupted sleep, certain foods, or fluctuations in estrogen related to women's menstrual periods. But the underlying issue is "deep in the brain," Mathew said.

    It "doesn't make sense," Halpern said, that removing a piece of facial muscle would eliminate a complex brain disorder for large numbers of people.

    So why would study patients get relief from surgery? One likely culprit, Mathew said, is the "placebo effect" -- a patient's belief that a procedure worked.

    He also suspects some study patients actually had pain stemming from a compressed nerve, which was relieved by surgery. Some may have had migraines, too, perhaps triggered by that compressed nerve. In those cases, easing the pressure might have reduced migraine attacks.

    Halpern agreed that surgery could conceivably remove a migraine trigger for some people. "No one is saying this shouldn't be studied as a treatment," she said.

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