Surgical treatment of migraine safe and effective

Jul 31 2009

Migraine headaches are a drain - not only on the estimated 30 million Americans who suffer from them, but on the economy, too. Because pain and other symptoms caused by migraine headaches can be quite severe, it is projected that nearly $13 billion is spent every year in headache treatment and loss of time from work, which no one can afford these days.

But according to a new study in Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS), there is hope for severe and frequent migraine sufferers who can't find relief in conventional remedies.

"Nearly one out of four households, including 18 percent of women, suffer from migraines and many patients are not only eager, but desperate to stop the pain," said ASPS Member Surgeon and study author Bahman Guyuron, MD, professor and chairman, department of plastic surgery, University Hospitals Case Medical Center. "In this study, we've shown that surgical treatment of migraine headaches is safe, effective, and that this reasonably short operation can have a colossal impact on the patients' quality of life - all while eliminating signs of aging for some patients, too."

For nearly a decade, researchers have been testing the concept that migraines are caused when a person's trigeminal nerve branches are irritated. When the muscles around these branches are incapacitated, the headaches stop, which is why some patients have found relief from the 'freezing' effect of Botox treatments. However, according to this study, removal of these muscles or 'triggers,' offers an easily attainable and permanent fix.

In this double-blind, placebo controlled clinical trial, researchers (including a plastic surgeon and two neurologists) from Case Western Reserve University and University Hospitals Case Medical Center in Cleveland, identified the three most common trigger sites and then randomly assigned 75 patients to either the actual (49 patients) or sham-surgery groups (26 patients). Patients then completed questionnaires and underwent either a real or perceived deactivation operation on their predominant migraine trigger site, which for most patients, was similar to that of a traditional forehead lift.

One year later, 57 percent of the patients in the actual surgery group reported complete elimination of migraine headaches, compared with only 4 percent in the sham surgery group. Furthermore, 83 percent of the actual surgery group observed at least a 50 percent reduction in migraines. And while there was a high (57 percent) incidence of symptom improvement in the sham surgery group, which has been similarly reported in other studies and could be attributed to the placebo effect, among other things-researchers point out that the difference in migraine improvement and elimination reported by the two groups was statistically significant.

"Though one might not think to look to plastic surgeons to treat migraines, we are commonly involved in peripheral nerve surgery and treat nerve- related pain, so this is a meaningful addition to the field of reconstructive plastic surgery," said Dr. Guyuron. "And I can say that these procedures are the most rewarding for me, because these are the patients that come back and report that their lives have been changed."