Migraine Surgery Ends Pain in Nearly One Third of Patients

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Surgery that targets specific trigger sites can end migraine pain in nearly one third of patients and significantly reduce it in about 90 percent of patients, according to a new study. The migraine surgery technique was developed after success was seen following a cosmetic procedure.

Migraine surgery has good five-year results

Plastic surgeon Dr. Bahman Guyuron, of Case Western Reserve University and the Cleveland Clinic, developed a migraine surgery technique after he noticed some of his patients who suffered with migraines experienced significant improvement in migraine pain after they underwent cosmetic forehead-lift procedures. He evaluated his technique in 69 migraine patients.

Guyuron’s technique involves “surgical deactivation” of specific trigger sites in muscles or nerves that produce pain. To identify which sites are triggers for each individual, patients were tested with Botox (botulinum toxin A) before surgery.

Most patients had at least two trigger sites that required treatment. If a patient suffered with frontal migraine that started in the forehead, for example, he or she had the muscles in that area removed. This approach may reduce migraine pain by reducing pressure on nerves in the frontal area.

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The five-year results showed that 88 percent of patients had a positive response to the surgery: 59 percent reported a significant decrease in migraine-related pain and 29 percent said their migraines had disappeared completely. The remaining 12 percent of patients reported no change in their migraines.

Among the improvements was a decrease in migraine frequency from an average of eleven to four per month. Duration of migraines also declined from an average of 34 hours to eight. Patients also reported a significant improvement in quality of life.

More than 29.5 million people in the United States experience migraine, according to the National Headache Foundation. Most people treat their migraine pain with medication, either over-the-counter or prescription, while there are also nondrug approaches, including biofeedback, oxygen therapy, magnetic stimulation, and herbal remedies.

The authors note that the positive outcomes from the migraine surgery “provide strong evidence that surgical deactivation of one or more trigger sites” can effectively end or significantly reduce the frequency, duration, and intensity of migraine. Future research will focus on refining the migraine surgery technique and more clearly identifying how surgical deactivation of trigger sites works.

SOURCES:
Kung TA et al. Plastic & Reconstructive Surgery 2011 Jan; 127(1): 181-89
National Headache Foundation

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