ARLINGTON HEIGHTS, Ill. - Migraine headache sufferers get significant relief or elimination of symptoms through modifications of plastic surgery procedures traditionally used to minimize facial wrinkles, reports the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
In a study of 29 patients conducted by board-certified plastic surgeon Bahman Guyuron, MD, and neurology colleagues at Case Western Reserve University in Cleveland, Ohio, 95 percent of patients who had surgery to remove the corrugator supercilii muscles in the forehead (vertical frown muscles), reported considerable relief or elimination of migraine symptoms during an average follow-up period of approximately one year. A small branch of the trigeminal nerve, a large cranial nerve located near the temple, essential for chewing and sensibility of the face, was also detached during surgery.
To screen migraine sufferers for surgery, Dr. Guyuron gave patients Botox injections to temporarily paralyze the corrugator muscle. Botox, or botulinum toxin type A, was recently approved by the FDA for cosmetic use to smooth and reduce facial wrinkles. If patients reported improvement after Botox injections, surgery to remove the muscle was recommended.
"Our study confirms that surgery is a very effective treatment for people suffering from debilitating migraine headaches," said Dr. Guyuron. "All patients who had surgery to remove their corrugator muscle also responded positively to Botox treatment proving that it is a reliable predictor of surgical outcomes."
After receiving Botox injections in the corrugator muscle, 82 percent of patients (24 out of 29) noticed improvement or complete elimination of their migraine headaches, 55 percent had complete elimination of headaches and 28 percent had significant improvement for six consecutive weeks or more. Patients had migraines less often - down from 6 to 2 per month - and headaches were less severe or painful.
Twenty-two patients who responded favorably to Botox treatment were considered suitable candidates for surgery. Of the 22 patients who had surgery, 95 percent (21 patients) had improvement of their migraine headaches. Forty-five percent of patients reported elimination of headaches and 50 percent noted a significant improvement of symptoms. The average intensity of migraine headaches for the entire surgical group fell considerably, and the frequency decreased from 5 to less than 1 per month.
Of the patients selected for the study, 24 were women and five were men, closely matching the national gender-based distribution of the migraine headache population. The patients ranged in age from 24 to 63 years.
A reported 26 million Americans, 18 percent of women and six percent of men currently suffer from migraine headaches. One-third of patients with periodic or chronic migraine headaches find no relief from standard therapies. While the triggers for migraine headaches remain largely unknown, Dr. Guyuron believes that manipulation or removal of specific non-functional facial muscles may ultimately result in a cure.
The authors continue their research for a cure and are currently working on a larger, 125 patient, randomized study to find additional trigger points for migraine headaches to offer a greater chance for their elimination.
"The results of this study are truly encouraging," said Dr. Guyuron. "Since 95 percent of patients responded positively to surgery without significant complications, we can conclude that surgical treatment of migraine headaches is both safe and successful. Even in patients who did not experience complete elimination of migraine headaches, the reduction in frequency achieved was remarkable. Additionally, all patients received the added bonus of a rejuvenated forehead."
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