Suffering From Migraines? Get a Forehead Lift

April 10, 2012— -- Since high school, Michael Calderone's migraine headaches have been so crushing that life his life would just stop.

"I would come home in the summer after working and go pass out in a dark room with a headache so bad I would lose the rest of the day," said Calderone, a 52-year-old who runs a building electronics company in Cleveland. "I was totally dysfunctional until I passed out."

The headaches only got worse as he grew older.

"If it hit in the morning, I would lose a whole day and the next day until it would cycle down," he said. "No bright lights, no stress, no activity at all -- just not to agitate your head so it would not get worse."

That was until he met Dr. Bahman Guyuron, chair of the department of plastic and reconstructive surgery at University Hospitals Case Medical Center.

Guyuron had pioneered a surgical technique that he had discovered by accident while doing cosmetic surgery on women.

In July 2008, Guyuron gave Calderone a forehead lift, freeing entrapped nerves behind his eyes that had caused chronic and excruciating pain on the left side of his face.

And today, the migraines are gone.

"At one point I was getting them every day --- I was incapacitated," said Calderone. "Now, I feel like I have my life back."

According to the Migraine Research Foundation, an estimated 36 million Americans -- about 10 percent of the population, suffer from migraines. They are not just headaches, but an array of neurological symptoms that can include throbbing head pain, nausea and visual disturbances.

Migraine ranks in the top 20 of the most disabling medical conditions. Three times as many women as men are afflicted, according to the foundation, which funds research and provides medical resources for patients.

Migraines tend to run in families. Both Calderone's 21-year-old daughter and his niece have them.

Attacks can last between four and 72 hours and may include nausea, vomiting, as well as extreme sensitivity to sound, light, touch and smell. Tingling or numbness can also occur in the extremities or face.

But now, plastic surgeons, many of whom have been trained under Guyuron, are offering nerve decompression surgery. He theorizes that 90 percent of all migraines are caused by irritation of the peripheral branches of the trigeminal nerve.

Guyuron first discovered the connection between migraine and nerve compression by muscles, vessels and bone 12 years ago.

"A surgeon's wife had a forehead lift and came for a follow-up with me," he said. "She told me she was not only happy with the way she looked, but she hadn't had a migraine for the previous six months."

"I thought it was a coincidence, but another patient told me the same thing," said Guyuron.

So he investigated 314 patients who had undergone forehead lifts over the previous decade, revealing that 31 of 39 who reported migraine headaches saw "significant improvement."

"That was the beginning," he said.

A Guyuron-led study published in the journal Plastic and Reconstructive Surgery in 2009, found that nearly 85 percent of patients who underwent the nerve decompression surgery had a 50 percent reduction in migraine.

His work suggests that migraine arises from irritation in the nerves, which releases toxins and begins a "cascade of events that end up being a full-blown migraine in the head."

According to Guyuron, there are four common trigger points on the face and four less common ones. Most are on the forehead, temple, back of the head and behind the eyes.

"Each one has a different mechanism and reason for the nerves being irritated, and we have developed a surgical technique for each trigger," he said.

Plastic Surgeons Try Botox First

Surgery is done on an outpatient basis and lasts about 45 minutes to an hour for each trigger point that is deactivated. In three out of four cases, it is a muscle that is compressing the nerve, though it can be bone or even the cartilage of a deviated septum.

Guyuron first tests a patient with Botox, which paralyzes the muscle, to see if it has a positive effect. "If they respond to Botox, I know they will respond to surgery well," he said.

For Calderone, Botox injected above his left eyebrow and it had a remarkable effect.

"It would stop it for three or four months, then the migraines would begin again," said Calderone. "But it was still better than getting them every day."

But after three years, he decided to look to a more permanent treatment.

Calderone paid $10,000 out of pocket for his surgery, but he estimates he was spending nearly as much on Botox, injections and medications.

Guyuron operated on the muscle across his nose. "In three and a half years, I haven't gotten a migraine, just tension headaches."

"I can now tell you what a tension headache is -- and it's nothing. And a sinus infection -- nothing," he said. "It doesn't progress."

Guyuron said most patients, like Calderone, have found that medications don't work or they are unhappy with side effects.

But Cathy Glaser, a retired lawyer and founder of the Migraine Research Foundation, said she is not convinced surgery is a cure-all for migraines.

"It's a very complex disease and there are difference kinds of migraines and we don't know the cause," she said.

Nerve decompression is only one of about five different surgical techniques from repairing a hole in the heart to implanting electrodes to stimulate the nerves.

"Surgical interventions are really an end-of-the-line treatment and not something you are going to do when you are first diagnosed," said Glaser. "It's very extreme and there are side effects."

Infection and bleeding can occur, as well as some numbness associated with the surgery that can be long-lasting or permanent. Rarely, minimal hair loss around the incision site can result.

"They go in and open up your head and play with the nerves," said Glaser. "It's a pretty big intervention … You have to be careful when you read the headlines about a cure. But it does help some people."

She said studies have been in a population that is small and very selective -- those for whom other therapies have been unsuccessful.

Insurance companies are reluctant to cover the procedure while it is still considered somewhat experimental. "The measure of efficacy is different in a lot of studies -- there isn't a gold standard," she said.

Causes of migraine can include hormonal fluctuation, particularly in women, and genetic disposition. If one parent has migraine, a child has a 40 percent chance of developing it. With both parents, it rises to 90 percent, according to Glaser.

Such was the case with her daughter Samantha, who has had migraines since the age of 3 -- nearly daily since seventh grade.

Glaser and her husband began the organization seven years ago when they saw that there was no foundation dedicated to research and a paucity of information.

While Samantha was in residential treatment at the Michigan Headache and Neurological Institute, they saw "people of all ages whose lives were destroyed by headaches."

Today, Samantha Semlitz is 23 and supports her parents' work. Despite daily pain, she is getting her master's degree in early childhood education at Fordham University and teaches at a school in Harlem.

Her headaches build during the day to a crescendo of "throbbing pain" at night. Semlitz is on medication and said she would not consider surgery -- at least not yet.

"I have thought about it, but decided against it," she said. "I am not that desperate."

"I've had it them so long, I have learned to cope with them," she said. "I haven't known anything different."

But she is eager to see more research and helps monitor a Facebook page for the foundation and a group page for those who suffer from migraine.

And she continues to work for more research, but understands the challenges in fundraising.

"It's hard," said Semlitz. "Because people don't die from migraine -- you can't pull out the death card."

But she knows how desperate patients are. "You feel completely incapacitated, and feel like you are dying."

To learn more, go to the Migraine Research Foundation.