But Surgery Only Performed on Hard-to-Treat Migraine Patients
WebMD Health News
Reviewed By Brunilda Nazario, MD
July 31, 2009 -- Stacy Porter, 29, can't remember a time when she didn't suffer from crippling, relentless migraines before having the surgery that changed her life eight years ago.
"I was diagnosed with migraines when I was 2 years old," the New Philadelphia, Ohio, marketing executive tells WebMD. "I had about 15 days a month of severe migraine pain."
Her symptoms included throbbing pain in her temples, nausea, and sensitivity to light so severe she remembers wearing sunglasses to more than one final exam in high school and college.
None of the drugs used to prevent migraines helped, so her only relief came from medications that eased the pain but left her feeling drugged and out of it.
That all changed at age 21 when she had a surgery similar to that typically performed to remove crow's feet.
"After that I never had another migraine," she says.
Plastic surgeon Bahman Guyuron, MD, of Case Western Reserve University, says Porter's results are common, and his newly published study backs up the claim.
Forehead Lift Lifts Migraines
Guyuron has treated more than 400 migraine patients with a modified version of a traditional forehead lift over the last decade, and he tells WebMD that the vast majority of them have shown dramatic improvement.
His newly published study was designed to convince critics still skeptical of using plastic surgery to treat migraines.
Guyuron and colleagues randomly assigned 75 patients with migraine trigger sites in just one area to receive either real or sham surgery. The patients were not told which type of surgery they were getting.
In the real surgery group, nerves were cut at specific migraine trigger sites. In some cases, like Porter's, the nerve was the same one cut to eliminate crow's feet. In others, the nerve was the same one cut to ease frown lines on the forehead.
The surgery works like Botox injections -- now widely used, though not approved, for the treatment of migraines.
In fact, patients in the active-surgery group got Botox injections first to determine if they were good surgical candidates.
In all, 49 patients had the actual surgery and 26 had the sham surgery.
One year later, 83% of the actual surgery group reported at least a 50% reduction in migraines, compared to 57% of the sham surgery group.
Even more surprising, 57% of actual surgery patients reported complete elimination of migraines, compared to just 4% of sham surgery patients.
The study appears in the August issue of the journal Plastic and Reconstructive Surgery.
"You don't see results like this in migraine studies," Guyuron says. "Even the most skeptical people will have to accept there is something to this."
Surgery Not for Everyone
But surgery is not a good option for patients who have infrequent migraines and those who respond to preventive treatments, he says.
"We are talking about 10% to 15% of migraine patients who would be good candidates for surgery," he says.
Neurologist Richard B. Lipton, MD, who directs the headache unit at Montefiore Medical Center in the Bronx, says the study's design and its dramatic outcome helped convince him the surgical approach is legitimate.
"I started out quite skeptical about this," he says. "But despite my best efforts not to be, I'm pretty excited about the results."
Lipton did express concern that the study participants may have actually known which treatment they were getting, which might have affected the results.
Alexander Mauskop, MD, who directs the New York Headache Center, had the same reservation about the trial.
Mauskop was one of the first headache specialists in the nation to routinely use Botox for migraines, and he now treats between 60 and 70 patients a month, with a 70% response rate.
Patients typically get Botox injections every three months, at a cost of $750 to $1,000 per injection.
"The problem I have with surgery is that headaches come and go," he says. "They may go away with menopause or at some other time. Surgery is a permanent treatment for a condition that is rarely permanent."
Mauskop offers his patients many treatment options ranging from traditional drug therapies to alternative approaches like acupuncture.
Robert Kunkel, MD, has treated migraines for four decades at the Cleveland Clinic, and he serves on the board of the National Headache Foundation.
He tells WebMD he has seen several surgical approaches come and go during his career.
"There is always a lot of excitement, but none has really lasted," he says.
But Porter says there is no doubt in her mind that, like her, many, many patients with intractable migraines can be helped with the surgery.
"It completely changed my life," she says. "I went back to see Dr. Guyuron for checkups for seven years, first every month and then less frequently. And he and I both got teary-eyed every time I went in."
SOURCES: Guyuron, B., Plastic and Reconstructive Surgery, August 2009; online edition. Bahman Guyuron, MD, professor and chairman, department of plastic surgery, University Hospitals Case Medical Center, Cleveland, Ohio. Richard B. Lipton, MD, director, Montefiore Headache Unit, Montefiore Medical Center, Bronx, N.Y. Alexander Mauskop, MD, director, New York Headache Center, New York. Stacy Porter, former migraine patient, New Philadelphia, Ohio. Robert Kunkel, MD, consultant, Cleveland Clinic; spokesman, National Headache Foundation.
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