Can Surgery Relieve Migraine?
An American plastic surgeon is claiming to have found a surgical treatment that can relieve severe migraines. The work of Bahman Guyuron who is a Clinical Professor of Plastic Surgery in Cleveland, Ohio at the Case Western Reserve University has been profiled on a news channel in the USA and, on first look, seems to be a promising treatment. However, his methods have not been accepted by mainstream medicine. Is this because the method doesn’t actually work, or is it because neurosurgeons just don’t trust a plastic surgeon to have devised a useful treatment?
Surgery for MigraineDr Guyuron’s technique involves making fairly superficial cuts into the muscle and nerves that take messages from the surface of the head into the brain, where they are perceived as pain. He has explained that he discovered that these types of incisions could relieve migraine totally by accident when doing face lifts and other cosmetic surgery. Patients who had undergone a face lift that included a brow lift, where the skin over the forehead was separated from the underlying tissue, reported a dramatic improvement in their migraine symptoms.
The improvement rates that he claims are extremely high – over 90 per cent of people who have the surgery say they their migraines are significantly less troublesome. The programme on NewsChannel5 carried plenty of testimonials from former migraine sufferers who were delighted with the results of their surgery. Around three quarters of Dr Guyuron’s patients say that they have been completely migraine free since having the surgery.
Evidence that Surgery Helps MigraineDr Guyuron has been perfecting the technique for some time. In 2001, the British science magazine, New Scientist, reported the results of his small observation trial of his forehead surgery. In total, the report included data from 300 of his patients who had been given a face lift. Thirty-nine of them had suffered from severe migraines before their facelift and thirty-one of them reported that their headaches never returned after the operation. Half said they noticed great improvements while the other half said they never had another migraine after the surgery.
Dr Guyuron’s explanation also seems convincing. He says that the forehead lift removes a muscle called the corrugator supercilli, which is the muscle that we use to be able to frown. Cutting this muscle so that it cannot work anymore eases the frown lines on the forehead, and is an important part of the forehead lift. While there are many things that will trigger a migraine, the underlying mechanism that leads to pain involves the trigeminal nerves, which suffer local inflammation. These trigeminal nerves pass through to the brain through this very muscle.
Dr Guyuron thinks that cutting the muscle makes it less likely that the nerves passing through the area get put under pressure, so the migraine never starts.
Finding Out Which Migraines Will RespondOne of the most convincing parts about the claims of Dr Guyuron is that fact that he pre-tests patients to see if they will benefit from the surgery. He does this by injecting Botox, the oft-used cosmetic surgery drug, to paralyse the corrugator supercilli muscle. This has the same effect as surgery to cut the muscle, but it is only temporary. However, it does provide a window to examine the effect that the muscle has on the migraines of individual sufferers. If the Botox treatment cures their migraines for 3-4 months, and then they return, the surgery to actually cut the muscle can be done as a follow up to permanently cure the migraines. The operation is very short and needs only a 2 centimetre incision and takes about half an hour.
Many doctors would like to see larger trials to make sure the technique does actually work but the rationale behind it and the evidence available so far does make it look like a very promising new migraine treatment.