Plastic Surgery for Migraines?

High Success Rate Claimed for Controversial Approach

From the WebMD Archives

Oct. 28, 2003 -- Plastic surgery can relieve migraine headache pain, a controversial study suggests.

The technique could help at least half of all migraine sufferers, claims Bahman Guyuron, MD, clinical professor of plastic surgery at Case Western Reserve University in Cleveland. Guyuron is medical director of the Zeeba Ambulatory Surgery Center in Lyndhurst, Ohio. Last year, he launched the American Migraine Center to offer surgery to migraine patients.

"We were encouraged by our previous pilot study, but the feedback from this study was overwhelming," Guyuron says in a news release. "We had patients whose lives were continually hampered by migraine headaches who now can perform at work and freely live their lives."

The current findings come in his presentation to Plastic Surgery 2003, the annual scientific meeting of the American Society of Plastic Surgeons, the Plastic Surgery Educational Foundation, and the American Society of Maxillofacial Surgeons.

From Frown Lift to Migraine Treatment

Guyuron says his discovery of the surgical technique came after several patients who had forehead lifts reported migraine relief. This led him to the theory that many migraine patients have one or more of four "trigger points." Muscles that contract around nerves in the face, he suggests, trigger a domino effect that results in migraine pain.

There are four of these trigger points, Guyuron says:

  • The forehead. Treatment: Remove frown muscles.
  • The temple. Treatment: Remove small portion of facial nerve in temple region.
  • The back of the neck. Treatment: Remove small portion of muscle, replace with fat to prevent regenerating muscle from pinching nerve.
  • The nose area. Treatment: Straighten septum and remove part or a full length of the turbinates (plates of cartilage in the nose).

To see if surgery might work, Guyuron first uses Botox to paralyze the trigger points. In the current study, 90 of 91 patients went on to surgery after the Botox test. Most were treated at more than one trigger site.

Of the 88 patients -- 82 of them women -- for whom data is available, 83 said they felt better after surgery. More than one in four patients (29.5%) said their migraines completely went away after treatment.

"While we're thrilled that the surgical techniques produced such positive results, the team will continue to research migraine headaches, improve the ways in which we identify trigger sites, and strive to elimination of this condition for the majority of patients," Guyuron says.

Help or Humbug?

Headache specialists do not generally accept Guyuron's theory that most migraines begin in the facial nerves, says Donald B. Penzien, PhD, director of the head pain clinic at the University of Mississippi Medical Center.

"Most migraine specialists believe the focus of migraines to be in the brain, not in the face," Penzien says. "Is this surgery really impacting the cause of migraine? I don't know of any major studies supporting this. It is very premature to recommend this as a treatment, especially those that have an impact. And any time you cut somebody open, there is a risk. Why should we be subjecting people to the knife when we have validated treatments for migraines? I'd like to see the science first before we tout this as the latest cure."

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SOURCES: Plastic Surgery 2003, San Diego, Oct. 25-29, 2003. News release, American Society of Plastic Surgeons. Donald B. Penzien, PhD, director, head pain clinic, University of Mississippi Medical Center, Jackson.
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