Large Experience Shows Improvements in Specific Migraine Symptoms and 'Triggers', Reports Plastic and Reconstructive Surgery

PHILADELPHIA — For patients with migraine headaches associated with a temporal "trigger site," a surgical technique specifically addressing that site provides excellent headache relief, according to an experience reported in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

ASPS Member Surgeon Dr. Bahman Guyuron and colleagues of University Hospitals Case Medical Center, Cleveland, report their 10-year experience with "surgical deactivation" in patients with for temporal migraine headache (TMH).

"These results provide strong support for the efficacy of surgery to reduce TMH frequency, duration, and severity," the researchers write.

High Success Rate with Surgery for Temporal Migraine Headache

The study included 246 patients undergoing surgery for TMH, performed by Dr. Guyuron, between 2000 and 2011. Dr. Guyuron developed the surgical deactivation approach after noticing that some migraine patients had reduced headache activity after cosmetic forehead-lift procedures.

Dr. Guyuron has developed surgical techniques targeting the muscles or nerves that produce pain in four trigger sites. In patients with TMH, headaches result from muscle contraction around a specific nerve located at the side of the head (temple). Site-specific surgical deactivation disconnects this nerve to prevent it from triggering headaches.

Before surgery, the temporal trigger site was confirmed by testing with botulinum toxin A (Botox), or sometimes by specific patterns of symptoms. Most patients also underwent surgery for additional migraine trigger sites (for example, frontal migraine) at the same time.

Temporal migraine surgery resulted in significant improvement in headache symptoms. Surgery was rated successful in 85 percent of patients, with at least 50 percent improvement in TMH. In 55 percent of patients, temporal headaches were eliminated completely.

New Insights into Specific TMH Symptoms and Triggers

Overall, TMH frequency was reduced by an average of 68 percent, headache duration by 41 percent, and headache severity by 66 percent. The results were similar regardless of age, sex, or follow-up time.

The study also identified several specific TMH symptoms and migraine "triggers" that were relieved or eliminated by surgery. The symptoms included being bothered by light and noise, difficult concentrating, blurring vision, and drooping eyelid (ptosis).

Migraine triggers that were improved by surgery included letdown after stress, air travel, bright light, loud noises, fatigued, weather changes, and certain smells.

The study is the largest to examine the results of surgical deactivation for TMH. The results strongly support the effectiveness of the procedure—nearly all patients had significantly reduced headache activity and more than half gained complete relief from TMH.

The information on specific symptoms and triggers associated with TMH is valuable for identifying migraine trigger sites, Dr. Guyuron and coauthors. In at least some cases, this may allow accurate diagnosis while avoiding the additional and costly step of testing with Botox injection. The researchers write, "Future research will describe outcomes and associated symptoms and triggers for each of the other surgical sites."

Plastic and Reconstructive Surgery is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery (PRS)® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, PRS brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

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About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. 

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