Can plastic surgery cure migraines?
A plastic surgeon noticed that patients were headache-free after receiving forehead lifts and a surgical 'cure' to migraine headaches was born.
Tue, Sep 08 2009 at 10:11 AM
Photo: Fog City Productions/Jupiterimages
Can plastic surgery cure more than furrowed brows, frown lines and droopy eyelids? Maybe so, according to a study that suggests a forehead lift can “cure” migraine headaches.
The double-blind study, published in the journal Plastic and Reconstructive Surgery, found that more than 80 percent of patients who had surgery in one of three “trigger sites” -- forehead, temples, or back of the head -- had fewer headaches than 55 percent of patients in a placebo group. On top of that, more than half the patients who had the surgery reported “complete elimination” of headaches, compared to 4 percent of patients who had a “sham” surgery but said their headaches were gone.
However unlikely, that’s big news for nearly 30 million Americans who suffer from migraines for 15 days a month or more. Because doctors do not know what causes migraines, many patients try drug after drug to relieve head pain and nausea.
Of course, forehead lifts are most common among patients looking to smooth their worry lines. But about a decade ago, Dr. Bahman Guyuron, the lead author of the study, observed that some of his patients said their migraines improved post-operation.
The theory behind Guyuron’s treatment is to alleviate the nerve irritation behind migraines. Some migraines occur when facial and neck muscles compress sensitive nerve branches; thus, “deactivating” those muscles could relieve headache pain.
The actual procedure is not your classic facelift. The surgery to “cure” migraines adds fatty tissue to nerves. (It also removes frown muscles.) So far, Guyuron has trained 150 doctors to perform the procedure.
It is a similar rationale to the off-label use of Botox to treat migraines. A few years ago, another serendipitous discovery -- this time by dermatologist Dr. Richard Glogau at the University of California, San Francisco -- promised between four and six months of headache relief after patients received Botox injections in their facial and head muscles. (Allergan, which manufactures Botox, is seeking FDA approval to treat migraines.)
Indeed, Guyuron theorized that surgery could provide prolonged relief to those patients who benefited from the temporary Botox treatment. In the study, only participants who responded positively to Botox were offered surgery.
Of course, there are skeptics. (How many headache specialists are plastic surgeons, after all?) Critics argue that patients who are appropriate for the procedure are the tip of the iceberg, not the majority. Others say further research is necessary and in the meantime surgery is, well, permanent. By contrast, you can always stop a medication.
“If I had a neurologist tell me there’s a new way of doing a facelift, I would have been very skeptical about it also,” said Guyuron, the chairman of plastic surgery at University Hospitals Case Medical Center in Cleveland. “But honestly I would have had an open mind.”
A word of caution, however. Doctors said they still don’t know if migraine sufferers who improved after the operation would be headache-free for life. But their skin? Smooth as can be.