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Plastic Surgery for Migraines?

Possibly a treatment; definitely not a cure.

by Teri Robert, Lead Expert

More than 36 million Americans live with Migraine disease. Finding effective preventive treatments can take years, wearing on the patience and will of Migraineurs.

Dr. Bahman Guyuron has developed a surgical procedure for Migraine prevention that has been a topic of conversation for a few years. This month, the results of a placebo-controlled trial of his procedure have been published in the journal Plastic and Reconstructive Surgery.

Study methods:

•  Patients with frequent moderate to severe Migraines that were triggered from "a single or predominant site" were interviewed.

•  Patients then kept a Migraine diary and a custom Migraine information form for one month.

•  At the end of that month, patients were examined by a neurologist and their Migraine diagnosis was confirmed utilizing the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II).

•  Patients were injected with Botox in their "predominant site," and only those who responded to Botox were eligible for participation.

•  76 patients with moderate to severe Migraines (by ICHD-II criteria) were enrolled as participants in the study. Trigger sites (where the Migraine pain originated) were identified.

•  Participants were randomly assigned to receive either actual (49 participants) or sham (26 participants) surgery in their predominant trigger site.

•  Participants completed the Migraine Disability Assessment (MIDAS), Migraine-Specific Quality of Life, and Medical Outcomes Study 36-Item Short Form Health Survey health questionnaires before treatment and at year follow-up, one year after the actual or sham surgery.

Study results:

  • One patient failed to complete the one-year follow-up and was removed from the study.

  • All participants took part in follow-up at three, six, nine, and 12 months after surgery with four types of outcome measured:

    • complete elimination of Migraine attacks

    • significant improvement in Migraine frequency, duration, or Migraine index (A migraine headache index was calculated by multiplying the frequency, intensity, and duration of migraine headaches, and this was compared with the baseline migraine headache index.1)

    • the difference between the baseline (beginning) and the 12-month follow-up

    • the difference between the average measures at baseline (beginning) and at 12-month-follow-up.

  • Of 49 participants to receive the actual surgery:

    • 19 underwent the procedure at the frontal site,

    • 19 underwent the procedure at the temporal site,

    • and 11 underwent the procedure at the occipital site.

  • Complete elimination of Migraine attacks:

    • 57.1% (28 of 49) who received the actual surgery reported being completely Migraine-free at 12 months.

    • 3.8% (one of 26) who received the sham surgery reported being completely Migraine-free at 12 months.

  • Significant improvement:

    • 83.7% (41 of 49) who received the actual surgery reported significant improvement at 12 months.

    • 57.7% (15 of 26) who received the sham surgery reported significant improvement at 12 months.

  • No change:

    • 16.3% (eight of 49) who received the actual surgery reported no change at 12 months.

    • 42.3% (11 of 26) who received the sham surgery reported no change at 12 months.

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