Migraine Surgery Offers Good Long-Term Outcomes
Five Years Later, Nearly 90 Percent of Patients Have at Least Partial Relief of Migraine Headaches
ARLINGTON HEIGHTS, Ill. - Surgery to "deactivate" migraine headaches produces lasting good results, with nearly 90 percent of patients having at least partial relief at five years follow-up, reports a study in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
In about 30 percent of patients, migraine headaches were completely eliminated after surgery, according to the new study, led by ASPS Member Bahman Guyuron, MD, chairman of Plastic and Reconstructive Surgery at University Hospitals Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, Ohio.
'Trigger Site' Surgery Reduces or Eliminates Migraine Headaches
Dr. Guyuron, a plastic surgeon, developed the migraine surgery techniques after noticing that some migraine patients had reduced headache activity after undergoing cosmetic forehead-lift procedures. The techniques consist of "surgical deactivation" of "trigger sites" in the muscles or nerves that produce pain.
For example, for patients with frontal migraine headaches starting in the forehead, the muscles in that area were removed, as in forehead-lift surgery. This procedure may reduce headache attacks by relieving pressure on a key nerve in the frontal area. Other approaches target other migraine trigger sites.
Before surgery, each patient was tested with botulinum toxin type A (Botox) to confirm the correct trigger sites. For most patients, surgery targeted at least two trigger sites. The five-year results - including standard measures of migraine-related pain, disability, and quality of life - were evaluated in 69 patients.
Eighty-eight percent of these patients had a positive long-term response to surgery. Headaches were significantly decreased in 59 percent of patients, and completely eliminated in 29 percent. The remaining patients had no change in headache activity.
Migraine attacks were less frequent after surgery; average migraine frequency decreased from about eleven to four per month. When attacks occurred, they didn't last as long - average duration decreased from 34 to eight hours. Migraine surgery also led to significant improvements in quality of life, with few serious adverse effects.
Migraines are a very common problem that can interfere with many aspects of daily life for millions of Americans. About one-third of patients are not helped by current treatments. The new surgical techniques have the potential to reduce or eliminate migraine attacks for many patients who do not respond to other treatments. A previous study found good results at one-year follow-up evaluation.
The new report shows that these good outcomes are maintained through five years follow-up. The findings "provide strong evidence that surgical deactivation of one or more trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headache, and the results are enduring," Dr. Guyuron and colleagues write. More research will be needed to refine the surgical techniques - as well as to clarify the reasons for the effectiveness of surgical deactivation of trigger sites in relieving migraine headaches.
Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.
About Plastic and Reconstructive Surgery
For over 75 years, Plastic and Reconstructive Surgery® 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, Plastic and Reconstructive Surgery® 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.
The American Society of Plastic Surgeons (ASPS) is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 93 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.
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