Surgery May Improve or Eliminate Migraines

By Jeff Minerd, MedPage Today Staff Writer

Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco December 31, 2004

Review

For some time, plastic surgeons had been receiving anecdotal reports about patients whose migraine headaches disappeared after forehead rejuvenation surgery, a procedure that entails removal of the corrugator supercilii muscle. Several preliminary studies supported these reports.

After further investigation to identify additional migraine trigger sites, the researchers. headed by Dr. Bahman Guyuron, clinical professor of plastic surgery at Case Western Reserve University, conducted the current study to assess the effectiveness of surgical procedures to deactivate the most common migraine trigger sites.

Of 125 volunteers diagnosed with migraine headache, 100 were randomly assigned to the treatment group and 25 to a control group. To identify migraine trigger sites in the treatment group, the researchers injected botulinum toxin A into each patient's potential trigger sites. If an injection resulted in elimination or significant improvement of migraines, the patient was considered a candidate for surgery.

Of the 100 volunteers in the treatment group, 89 completed the study. The mean follow-up for these patients was 396 days. The researchers gathered data at baseline and during follow-up on the frequency, intensity, and duration of patients' migraines. In addition, the investigators developed a Migraine Headache Index by multiplying these factors together.

At 1-year follow-up, statistical analysis showed significant improvements in all the measured variables in the treatment group when compared with the control group. Key results include the following:

• The mean monthly frequency of migraine headaches in the treatment group was 3.8 ± 0.4, compared with 10.2 ± 1.7 for the control group (P < .001).

• The mean intensity of migraines (on a scale of 1 to 10) for the treatment group was 4.0 ± 0.3, versus 7.0 ± 0.3 for the control group (P < .001).

• The mean duration of migraines (in hours) in the treatment group was 0.35 ± 0.05, compared to 0.99 ± 0.2 in the control group (P = .007).

• The Migraine Headache Index for the treatment group was 12.6 ± 3.1, versus 90.6 ± 33.6 for the control group (P = .03).

• Eighty-two of the 89 patients in the treatment group (92%) demonstrated at least a 50% reduction in migraine headache frequency, duration, or intensity compared with baseline data. Thirty-one of these patients (35%) reported elimination of their migraines.

• In comparison, only 3 of 19 control patients (15.8%) reported improvement, and no patients reported elimination of migraines.

• The mean annual cost of migraine care for the treatment group ($925) was significantly less than that for the control group ($5530).

"Surgical deactivation of migraine trigger sites can eliminate or significantly reduce migraine symptoms, " the researchers concluded. "Additional studies are necessary to clarify the mechanism of action and to determine the long-term results."