Porter Hospital Blog

The July 31st  Plastic and Reconstructive Surgery Journal published a new study showing that chronic migraine headaches were eliminated in more than half of patients who had a surgery that was essentially a brow (forehead) lift.  This relatively small study of 75 patients showed some striking results.   We talked about this study on the August 3rd Channel 7 morning news.

According to the study in the Plastic and Reconstructive Surgery Journal, incapacitating the muscles around the trigeminal nerve  (a nerve that is in the face and back of the head) relieves chronic migraines in 57 percent of the patients studied.  The surgery that was used in the study  was  essentially the same as getting a brow lift, a treatment traditionally used to help people look younger.    During the study, 40 patients had real surgery that incapacitated the muscles while 26  had  a sham surgery.  Neither the researchers nor the patients knew who had real vs  sham surgeries. 

Among the patients who had the real surgery, 57 percent reported complete elimination of migraine headaches during the one year foll0w-up.  Only 4 percent of the patients who had sham surgery reported elimination of headaches.

The theory behind this study is one that begain in 200o when a dermatologist at University of California San Francisco began studying the use of botox for cosmetic reasons.  In all research, a great deal of information about the patient’s health is collected to make sure there are not side effects that harm the patients.  In reviewing the data, Dr. Richard Glogau noticed that many of his patients who had chronic severe migraines were no longer having the headaches for up to six months after the injections.  He reported the results at a Dermatology meeting in Februrary of 2000 – a serendiptous finding during a study that was about another issue.
 This led to new research and the concept that the trigeminal nerve, which is the main nerve to the majority of muscles in the face, if irritated by muscle spasms in the face, can trigger a migraine headache.  The theory under study is that if a  medical intervention deactivates the muscle, so the nerve is no longer squeezed by the muscle, it thus relieves irritation of the nerve. 

The downside of both botox and surgery are the side effects of having the procedures and the cost, which is high.  Not everyone has migraines of such magnitude and frequency to justify the therapy.  So let’s review the other treatments available to treat migraines.

Treatments For Migraine Headaches

 The choice of treatment for migraines is very wide, including
1) Avoidance of certain trigger foods – red wine, some cheeses and some nuts
2) Stress modification
3) Over the counter pain medications such as acetaminophen and ibuprofen
4) Numerous preventive medicines that one takes daily, these include beta blockers and some Calcium channel blockers such as propranolol and cardizem
5) Medications such as Imitrex and Maxalt that help treat a migraine when it begins

Because this is sometimes complex, and there are other types of headaches that should be considered, this is a topic that needs careful history and examination and working with a physician or a neurologist to find the appropriate therapy for the individual patient.
 Seek immediate medical attention under these circumstances:
 
• Sudden start of “the worst headache ever”
• Comes on suddenly, any headache after a head injury, 
• Associated with changes in speech, movement or consciousness, and
• Any headaches associated with fevers or stiff neck need immediate attention
• A new type of headache over the age of 40
• Headaches that get worse with straining,  cough, sudden movement or exertion

For more information, you may want to look at these sites:

Porter Hospital Health Library

Denver Neurological Clinic

Science Daily