Cosmetic Op May Cut Migraine Pain

Removal of facial muscles may be solution for some migraine headache sufferers.

ByDavid Muir and Dan Childs
July 30, 2009, 6:45 PM

July 31, 2009— -- It's a debilitating pain that affects over 10 percent of the population -- some 30 million people in this country. Nearly one in four households have someone afflicted by migraines.

And no one knows that better than Theresa Schenk.

"I had the migraine syndrome for 20 years, and it really did own my life," Schenk, 62, said. "It was depressing, it was debilitating; it was something of a nightmare."

For two decades, no drug or treatment could help make the pain go away for the Willoughby, Ohio woman. And Schenk is far from alone; for many with migraines, standard treatment just doesn't work.

"There's a subset of patients who have what we call chronic migraine," said Dr. Lawrence Newman, director of the Headache Institute at St. Luke's-Roosevelt Hospital in New York. "Many of those people are quite treatment resistant. Why? We're not really sure.

"I tell our patients it is a life-altering condition," Newman said. "Having a migraine interferes with the person's life, their family members, their friends, their co-workers."

But now there may be new hope, from a common plastic surgery procedure – a discovery Dr. Bahman Guyuron, chairman of the Department of Plastic Surgery at University Hospitals Case Medical Center in Cleveland said he stumbled upon largely by accident.

"I operated on a patient who came for a follow-up after a forehead lift," Guyuron said. "Not only did she like the way she looked, she didn't have migraines headaches for six months since the surgery."

Other migraine suffering patients told him the same thing -- the forehead lift had made their migraines disappear.

While the origins of these headaches are often a mystery, research shows that the irritation of certain facial nerves by nearby muscles might be to blame in some cases.

Guyeron tells ABC News, that would explain the improvement his patients reported following a forehead lift because "what I do is remove the forehead muscles that pinch the nerve."

Doctors have also noted that patients treated with Botox often report migraine relief. Researchers believe that Botox relieves the source of these migraines by paralyzing the muscles surrounding these facial nerves. But could surgery offer a more permanent solution?

Surgery May Cut Migraine Pain For Some

In his small, double-blind study, Guyuron treated patients with migraines either with an operation that targeted three common trigger areas for migraine, or a fake "sham" surgery, which acted as a control.

A year after the procedure, 57 percent of patients in the actual surgery group reported complete elimination of headaches; only 4 percent of the sham surgery group did.

Some pain specialists not affiliated with the research said the results were encouraging. Dr. Richard Lipton, director of the Montefiore Headache Center in New York, noted that the study provides "fascinating and promising results" that could benefit patients with high levels of pain and disability for whom other treatment have failed.

However, some doctors said that the findings may not be as conclusive as they appear at first glance. Indeed, while 83 percent of the actual surgery group observed significant reduction in symptoms, so did 57 percent of those receiving the sham surgery.

Dr. Joel Saper, founder and director of the Michigan Headache and Neurological Institute in Ann Arbor, Mich., found this high placebo response rate "troubling."

"Overall, the study raises more doubts than provides answers," Saper said. "Surgery should be a last resort."

Dr. Robert Shapiro, professor of neurology at the University of Vermont College of Medicine in Burlington agreed that the high rate of patients who appeared to improve through receiving the placebo treatment suggested that the technique needs further study.

"It would be unfortunate if large numbers of migraine sufferers underwent expensive and potentially hazardous surgery which was actually no more effective than sham surgery," he said. "This study does not allow a conclusion to be drawn about the effectiveness of the surgeries performed."

Still, Schenk said, for her the results of the procedure were overwhelmingly positive.

"I get to be again the person I want to be," she said. "I can be effective mother, I am now a grandmother... I feel absolutely that it was a gift and it gave me my life back."

Courtney Hutchison contributed to this report.

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