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Facial Surgery May Offer Long-Term Migraine Relief for Some

Posted Feb 11 2011 12:00pm
healthnewslink

But it should be used only as a 'last resort,' expert cautions.

By Stacy Lipson
HealthDay Reporter

FRIDAY, Feb. 11 (HealthDay News) -- Facial surgery to "deactivate" painful migraines may offer some patients long-lasting relief, a new study suggests.

The vast majority of the study participants experienced partial relief from migraines, while one-third saw them disappear, the researchers reported.

Specifically, based on the findings in 69 patients in the five-year follow-up study, 88 percent experienced an improvement in symptoms, 59 percent noted a substantial decrease in symptoms, and 29 percent had their migraine headaches eliminated, the study authors found.

The research was published in the February issue of Plastic & Reconstructive Surgery.

Before surgery, patients were given Botox injections to identify which trigger sites caused the pain that they were experiencing. One surgery involved disruption to the frowning muscles in the forehead and relieving pressure on key nerves, the researchers explained. Other surgical options included the temple trigger site and the back of the head, where nerves can also cause migraine headaches.

Dr. Bahman Guyuron, chairman of Plastic and Reconstructive Surgery at University Hospitals at Case Medical Center and Case Western Reserve University School of Medicine, estimates this surgery may cost around $4,000, and that about half of his patients are paying for their surgery with insurance.

For the minority of patients for whom this surgery did not work (12 percent), Guyuron pointed out that patients could be left with a somewhat immobilized face, while still experiencing migraines.

But in his view, "the immobilization only involves the frowning muscle, which not only is not detrimental to the face, it actually makes the face younger and happier."

In his studies, Guyuron noted that he became interested in treating migraines resistant to medical management (that is, those in which the migraine drugs typically used didn't work). In 2009, he led a study that compared a control group of patients getting "sham" surgery with another group receiving surgery on one of three trigger points. He and his colleagues found that 57 percent of the treatment group reported complete elimination of migraine headaches, compared to 4 percent in the fake surgery group.

As with any surgery, of course, there are potential complications. The risks of surgery on the forehead, for example, include unfavorable scarring, bleeding, infection, blood clots, facial nerve injury, numbness and intense itching, according to the American Society of Plastic Surgeons.

Adverse side effects among the patients in the current five-year study included skin numbness (two patients), hyper- or hyposensitivity (four patients) and mild neck weakness or stiffness (three patients), along with 20 patients who reported occasional itching.

According to statistics from the American Migraine Foundation, 36 million Americans have migraine headaches. Statistics show that 3 percent of the population is shown to have chronic migraines, which must be present for 15 days a month for the minimum of six months, in order to be considered chronic migraines.

Neurologist Dr. Jack Schim, of the Headache Center of Southern California, explained that patients with chronic migraines often suffer from terrible headaches, and are desperate for relief. According to Schim, chronic migraines can be disruptive to a person's lifestyle, and they can play a role in his or her quality of life.

However, Schim believes facial surgery should only be used as a last resort, and not as a first line of treatment for migraines. "The data needs to be replicated," said Schim. "It seems like an extreme measure."

Schim noted that other treatment measures, such as taking multiple oral medicines and getting nerve blocks, may be helpful before turning to surgery. Additionally, Schim also uses Botox treatment for his patients.

"Seventy to 75 percent of patients get a good improvement or full resolution of headaches from Botox," said Schim, in reference to his practice.

"If someone has tried everything, including avoiding medicine overuse, and addressed their lifestyle issues that could help or hinder headache problems, I would talk to the patient [about this] as an option," said Schim.

In October, the U.S. Food and Drug Administration approved Botox as an acceptable measure of treatment for chronic migraines.

More information

Find out more about migraines at the U.S. National Library of Medicine .

(SOURCES: Bahman Guyuron, M.D., chairman, Plastic and Reconstructive Surgery, University Hospital's Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio; Jack Schim, M.D., co-director and neurologist, The Headache Center of Southern California; February 2011 Plastic and Reconstructive Journal Surgery)

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