EFFECTIVE IN ELIMINATING/DECREASING MIGRANE HEADACHES, ASPS STUDY
SAYS . BOTOX® RELIABLE IN PREDICTING SURGICAL OUTCOMES.
Migraine headache sufferers get significant
relief or elimination of symptoms through modifications of plastic
surgery procedures traditionally used to minimize facial wrinkles,
reports the June issue of Plastic and Reconstructive Surgery®,
the official medical journal of the American Society of Plastic
In a study of 29 patients conducted
by board-certified plastic surgeon Bahman Guyuron, MD, and neurology
colleagues at Case Western Reserve University in Cleveland, Ohio,
95 percent of patients who had surgery to remove the corrugator
supercilii muscles in the forehead (vertical frown muscles), reported
considerable relief or elimination of migraine symptoms during
an average follow-up period of approximately one year. A small
branch of the trigeminal nerve, a large cranial nerve located
near the temple, essential for chewing and sensibility of the
face, was also detached during surgery.
To screen migraine sufferers for
surgery, Dr. Guyuron gave patients Botox injections to temporarily
paralyze the corrugator muscle. Botox, or botulinum toxin type
A, was recently approved by the FDA for cosmetic use to smooth
and reduce facial wrinkles. If patients reported improvement after
Botox injections, surgery to remove the muscle was recommended.
"Our study confirms that surgery
is a very effective treatment for people suffering from debilitating
migraine headaches," said Dr. Guyuron. "All patients
who had surgery to remove their corrugator muscle also responded
positively to Botox treatment proving that it is a reliable predictor
of surgical outcomes."
After receiving Botox injections
in the corrugator muscle, 82 percent of patients (24 out of 29)
noticed improvement or complete elimination of their migraine
headaches, 55 percent had complete elimination of headaches and
28 percent had significant improvement for six consecutive weeks
or more. Patients had migraines less often - down from 6 to 2
per month - and headaches were less severe or painful.
Twenty-two patients who responded
favorably to Botox treatment were considered suitable candidates
for surgery. Of the 22 patients who had surgery, 95 percent (21
patients) had improvement of their migraine headaches. Forty-five
percent of patients reported elimination of headaches and 50 percent
noted a significant improvement of symptoms. The average intensity
of migraine headaches for the entire surgical group fell considerably,
and the frequency decreased from 5 to less than 1 per month.
Of the patients selected for the
study, 24 were women and five were men, closely matching the national
gender-based distribution of the migraine headache population.
The patients ranged in age from 24 to 63 years.
A reported 26 million Americans,
18 percent of women and six percent of men currently suffer from
migraine headaches. One-third of patients with periodic or chronic
migraine headaches find no relief from standard therapies. While
the triggers for migraine headaches remain largely unknown, Dr.
Guyuron believes that manipulation or removal of specific non-functional
facial muscles may ultimately result in a cure.
The authors continue their research
for a cure and are currently working on a larger, 125 patient,
randomized study to find additional trigger points for migraine
headaches to offer a greater chance for their elimination.
"The results of this study are
truly encouraging," said Dr. Guyuron. "Since 95 percent
of patients responded positively to surgery without significant
complications, we can conclude that surgical treatment of migraine
headaches is both safe and successful. Even in patients who did
not experience complete elimination of migraine headaches, the
reduction in frequency achieved was remarkable. Additionally,
all patients received the added bonus of a rejuvenated forehead."
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