Aug. 25, 2000 -- Cosmetic surgery that banishes headaches as well as frown lines could be something to smile about. After having a "forehead lift," some patients with migraines have seen an unexpected benefit -- dramatic or even total headache relief, lasting up to four years or longer.
"Before the surgery, I was having migraines once every week or two, usually in the middle of the night," hairstylist Ron Myers tells WebMD. "My tongue would get thick and numb, then I'd lose vision first in one eye, then the other, and I could only see silver twinkles everywhere. Then I'd get an excruciating headache.
"Since the forehead surgery, I've had no symptoms at all. Now that I don't have the headaches, I really have a smile on my face," says Myers, age 61, of Columbus, Ohio.
"This is a significant development for patients with migraine headache," researcher Bahman Guyuron, MD, tells WebMD. Guyuron is a clinical professor of plastic surgery at Case Western Reserve University in Cleveland, and author of a study describing headache relief following forehead surgery in migraine patients.
Of more than 300 patients who had a forehead lift between 1989 and 1999, 39 reported having had migraine headaches before surgery, and 31, including Myers, noticed improvement in their headaches immediately after the surgery, Guyuron says. About half had dramatic relief, and the other half said their headaches disappeared completely.
"If these results are confirmed, this procedure might be useful in migraine relief, independent of the cosmetic effect," says Guyuron. He explains that the forehead lift, which involves taking out the forehead muscle that causes the brow to wrinkle, is a very minor outpatient procedure. It usually takes only 30 minutes, with two to three days of recovery before patients can resume their usual activities.
"I'd be very cautious in using this as a migraine treatment unless patients need plastic surgery for cosmetic reasons," Seymour Diamond, MD, director of the Diamond Headache Clinic in Chicago, tells WebMD. Diamond was not involved in the study.
Diamond explains that the results may be difficult to interpret for several reasons, including the small number of patients involved. Painkillers given after the surgery could cause immediate headache relief, and the natural tendency for migraine headaches to diminish with aging might explain the apparent long-term benefit.
"The unusual thing about this study is the remarkably long period of time these patients were [free of headaches]," David M. Knize, MD, tells WebMD when asked to review the study, which was published in the journal Plastic and Reconstructive Surgery.
Because this minor surgery apparently led to headache relief lasting four years on average, and 10 years in one patient, D. Hal Unwin, MD, in the journal article, calls it a "potentially revolutionary" treatment for migraine. Unwin is a neurologist at the University of Texas Southwestern Medical Center.
Conventional migraine medications must be taken daily for long periods to prevent headaches, while injections to abort a painful migraine attack are costly and inconvenient, and often must be given in a hospital emergency room.
"I've been told to use ice bags, go in a dark, quiet room, and even see a psychiatrist," Myers says.. "Suppositories and other medications only gave me temporary relief."
On Feb. 11, 1999, Myers had the forehead lift, which Guyuron had recommended to smooth out frown lines that Myers felt were making him look tired. "As time went on after the surgery, I realized that not only did I look much better, but I also had no more headaches," Myers says.
However, "in my own patient population of over 400 patients, I have not been able to confirm the experience of Dr. Guyuron," says Knize, an associate clinical professor of surgery (plastic surgery) at the University of Colorado Health Sciences Center in Denver. "I don't believe we should act on this as being a treatment for migraine until we can substantiate its effectiveness."
Only five or six of Knize's 400 patients had migraine headaches as defined by the strict guidelines of the International Headache Society, and only one of these patients noticed headache relief after surgery. Knize, Unwin and Diamond suggest that researchers should follow more migraine patients who've had forehead lifts before recommending the operation as a potential migraine treatment.
"Since some patients may have different [triggers] causing their headache, the procedure might not work for everyone," says Guyuron.
Along with a migraine specialist at Case Western, Guyuron is beginning a study of 20 patients with migraines. Before having a forehead lift, each patient will receive an injection of Botox, a medication that temporarily paralyzes the forehead muscle and also smoothes forehead lines. Earlier studies have shown that Botox can prevent migraines, and Guyuron is studying whether patients who get headache relief from the injection are more likely to have permanent relief when the muscle is removed surgically. Seven patients have been enrolled; six have had headache relief with Botox, and one is scheduled for surgery next week.
"If we confirm our earlier findings, this may facilitate insurance coverage for this procedure," Guyuron says."