14 February 2011

Facial surgery may treat migraines

Screening superior to other sideline tests in spotting early signs of brain trauma, researchers say


Facial surgery to "deactivate" painful migraines may offer some patients long-lasting relief, a new study suggests.

The vast majority of the study participants experienced partial relief from migraines, while one-third saw them disappear, the researchers reported.

Specifically, based on the findings in 69 patients in the five-year follow-up study, 88% experienced an improvement in symptoms, 59% noted a substantial decrease in symptoms, and 29% had their migraine headaches eliminated, the study authors found.

The research was published in the journal Plastic & Reconstructive Surgery.

Before surgery, patients were given Botox injections to identify which trigger sites caused the pain that they were experiencing. One surgery involved disruption to the frowning muscles in the forehead and relieving pressure on key nerves, the researchers explained. Other surgical options included the temple trigger site and the back of the head, where nerves can also cause migraine headaches.

Surgery for migraines

Dr Bahman Guyuron, chairman of Plastic and Reconstructive Surgery at University Hospitals at Case Medical Center and Case Western Reserve University School of Medicine, estimates this surgery may cost a lot.

For the minority of patients for whom this surgery did not work (12%), Guyuron pointed out that patients could be left with a somewhat immobilised face, while still experiencing migraines.

But in his view, "the immobilisation only involves the frowning muscle, which not only is not detrimental to the face, it actually makes the face younger and happier."

In his studies, Guyuron noted that he became interested in treating migraines resistant to medical management (that is, those in which the migraine drugs typically used didn't work).

In 2009, he led a study that compared a control group of patients getting "sham" surgery with another group receiving surgery on one of three trigger points. He and his colleagues found that 57% of the treatment group reported complete elimination of migraine headaches, compared to 4% in the fake surgery group.

As with any surgery, of course, there are potential complications. The risks of surgery on the forehead, for example, include unfavourable scarring, bleeding, infection, blood clots, facial nerve injury, numbness and intense itching, according to the American Society of Plastic Surgeons.

Side-effects of surgery

Adverse side effects among the patients in the current five-year study included skin numbness (two patients), hyper- or hyposensitivity (four patients) and mild neck weakness or stiffness (three patients), along with 20 patients who reported occasional itching.

According to statistics from the American Migraine Foundation, 36 million Americans have migraine headaches. Statistics show that 3% of the population is shown to have chronic migraines, which must be present for 15 days a month for the minimum of six months, in order to be considered chronic migraines.

Neurologist Dr Jack Schim, of the Headache Center of Southern California, explained that patients with chronic migraines often suffer from terrible headaches, and are desperate for relief. According to Schim, chronic migraines can be disruptive to a person's lifestyle, and they can play a role in his or her quality of life.

Surgery should be 'last resort'

However, Schim believes facial surgery should only be used as a last resort, and not as a first line of treatment for migraines. "The data needs to be replicated," said Schim. "It seems like an extreme measure."

Schim noted that other treatment measures, such as taking multiple oral medicines and getting nerve blocks, may be helpful before turning to surgery. Additionally, Schim also uses Botox treatment for his patients.

"Seventy to 75% of patients get a good improvement or full resolution of headaches from Botox," said Schim, in reference to his practise.

"If someone has tried everything, including avoiding medicine overuse, and addressed their lifestyle issues that could help or hinder headache problems, I would talk to the patient [about this] as an option," said Schim.

In October, the US Food and Drug Administration approved Botox as an acceptable measure of treatment for chronic migraines.

(Copyright © 2010 HealthDay. All rights reserved.)


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Headache expert

Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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