SAN DIEGO, CA – Migraine headaches afflict about 28 million Americans each year, often debilitating sufferers to the point they cannot conduct their daily lives. While many patients turn to prescription and over-the-counter drugs, these medicines often suppress the underlying condition rather than treat it. In a prospective, randomized, controlled study presented today at Plastic Surgery 2003, the annual scientific meeting of the American Society of Plastic Surgeons (ASPS), Plastic Surgery Educational Foundation (PSEF) and the American Society of Maxillofacial Surgeons (ASMS), a combination of new surgical treatments offers patients significant relief from migraine headaches, with 87 percent benefiting from the surgery long term and more than 35 percent reporting complete elimination of their headaches.

"Several years ago, when a couple of my patients mentioned to me that their headaches had disappeared serendipitously after forehead rejuvenation. I began an in-depth search into how the surgical techniques may have helped improve their headaches," said Bahman Guyuron, MD, ASPS member and study author. "Two neurologists on the research team examined the study patients to assure proper diagnosis of their migraine headaches. I then used methods I developed to identify the migraine trigger sites and deactivate them using the surgical techniques I designed."

The study found that of the 89 participants shared four central trigger points from where migraine headaches start – the forehead, temple, back of neck and nose area (septum and turbinates). While only 10 patients had one trigger site, 21 had two trigger sites, 28 patients had three trigger sites and 19 patients had all four trigger sites.

After the triggering facial muscles were injected with Botox®, the surgical team determined what type of surgery patients required. If they did not respond to the injections, the team considered surgery of the septum and turbinates for the patients.

"Imagine a tree that has multiple branches. That tree is a nerve on the face that provides sensation to the entire face. Some of these branches go through the muscles to get to the skin. When the muscles contract around those branches, they can trigger migraine headaches," explained Dr. Guyuron. "If one branch catches fire, it could spread to the rest of the tree, which is why these patients experience pounding in half of the head or the entire face and head. Our goal was to identify the branch most likely to catch fire and avoid the fire either by removing the offending muscle or cutting off that small nerve branch."

Surgery differed for all four trigger sites. For patients whose headaches started in the forehead, the surgical team removed the muscles that contribute to a person’s frowning function, eliminating the pinching effects on the nerves and stopping the domino effect that results in migraine headaches. For the temple region, surgeons removed a small portion of the nerve, preventing the pain from spreading on to the rest of the face.

In the back of the neck, they removed a portion of the muscle that was pinching a key nerve and replaced it with a small amount of fat to ensure that if the muscle regenerates, it would no longer pinch the nerve. For migraine headaches triggered from the nose area, the surgeons used a modification of a previously-reported method of straightening the septum and removing a segment or full length of the turbinates. Many of these patients enjoyed side benefits of breathing better through the nose in addition to reducing or eliminating their sinus and migraine headaches. When the surgery outcome was analyzed, considering each trigger site separately, positive results ranged from 90-100 percent. These numbers indicate that in the future, with better detection of trigger sites, more successful overall results can be expected.

Ten percent of the people in the United States suffer from migraine headaches, according to the American Council for Headache Education. In fact, Dr. Guyuron states that one in four households has someone who suffers from this debilitating and devastating affliction and that migraine headaches result in more than 112 million days of bed rest and loss of work in America each year.

"We were encouraged by our previous pilot study, but the feedback from this study was overwhelming," stated Dr. Guyuron. "We had patients, whose lives were continually hampered by migraine headaches, who now can perform at work and freely live their lives. While we’re thrilled that the surgical techniques produced such positive results, the team will continue to research migraine headaches, improve the ways in which we identify trigger sites and strive to elimination of this condition for the majority of patients."