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Comprehensive Surgical Treatment of Migraine Headaches

Guyuron, Bahman M.D.; Kriegler, Jennifer S. M.D.; Davis, Janine R.N.; Amini, Saeid B. Ph.D., M.B.A., J.D.

Plastic and Reconstructive Surgery: January 2005 - Volume 115 - Issue 1 - p 1-9
doi: 10.1097/01.PRS.0000145631.20901.84
ORIGINAL ARTICLES: RECONSTRUCTIVE, HEAD/NECK
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The purpose of this study was to investigate the efficacy of surgical deactivation of migraine headache trigger sites. Of 125 patients diagnosed with migraine headaches, 100 were randomly assigned to the treatment group and 25 served as controls, with 4:1 allocation. Patients in the treatment group were injected with botulinum toxin A for identification of trigger sites. Eighty-nine patients who noted improvement in their migraine headaches for 4 weeks underwent surgery. Eighty-two of the 89 patients (92 percent) in the treatment group who completed the study demonstrated at least 50 percent reduction in migraine headache frequency, duration, or intensity compared with the baseline data; 31 (35 percent) reported elimination and 51 (57 percent) experienced improvement over a mean follow-up period of 396 days. In comparison, three of 19 control patients (15.8 percent) recorded reduction in migraine headaches during the 1-year follow-up (p < 0.001), and no patients observed elimination. All variables for the treatment group improved significantly when compared with the baseline data and the control group, including the Migraine-Specific Questionnaire, the Migraine Disability Assessment score, and the Short Form-36 Health Survey. The mean annualized cost of migraine care for the treatment group ($925) was reduced significantly compared with the baseline expense ($7612) and the control group ($5530) (p < 0.001). The mean monthly number of days lost from work for the treatment group (1.2) was reduced significantly compared with the baseline data (4.41) and the control group (4.4) (p = 0.003). The common adverse effects related to injection of botulinum toxin A included discomfort at the injection site in 27 patients after 227 injections (12 percent), temple hollowing in 19 of 82 patients (23 percent), neck weakness in 15 of 55 patients (27 percent), and eyelid ptosis in nine patients (10 percent). The common complications of surgical treatment were temporary dryness of the nose in 12 of 62 patients who underwent septum and turbinate surgery (19.4 percent), rhinorrhea in 11 (17.7 percent), intense scalp itching in seven of 80 patients who underwent forehead surgery (8.8 percent), and minor hair loss in five (6.3 percent). Surgical deactivation of migraine trigger sites can eliminate or significantly reduce migraine symptoms. Additional studies are necessary to clarify the mechanism of action and to determine the long-term results.

Cleveland, Ohio

From Case Western Reserve University and the American Migraine Center, Zeeba Clinic.

Received for publication February 17, 2004; revised April 12, 2004.

Presented at the 72nd Annual Meeting of the American Society of Plastic Surgeons, in San Diego, California, October 24 to 29, 2003.

Bahman Guyuron, M.D., 29017 Cedar Road, Lyndhurst, Ohio 44124, bguyuron@aol.com

©2005American Society of Plastic Surgeons