Facial Surgery as a Treatment for Migraines Resistant to Medical Management

A recent study published in the journal Plastic and Reconstructive Surgery found that facial surgery can be used to provide long term relief from migraines. For the study 69 patients were examined over a five-year follow-up study with 88% experiencing an improvement in symptoms, 59% experiencing a substantial decrease in symptoms, and 29% experienced total elimination of migraine symptoms. Prior to the surgery, patients were given exploratory Botox injections to identify which trigger sites contributed to the headache pain they were experiencing. Based on the findings of the Botox injections, surgeons then disrupted either the frowning muscles in the forehead, temple trigger sites, or sites on the back of the head in order to relieve pressure on key nerves responsible for migraine symptoms. The average cost of this surgery was approximately $4,000 and the side effects included some immobility of the face, but “the immobilization only involves the frowning muscle, which not only is not detrimental to the face, it actually makes the face younger and happier,” said Dr. Bahman Guyuron, chairman of Plastic and Reconstructive Surgery at University Hospitals at Case Medical Center and Case Western Reserve University School of Medicine. Dr. Guyuron also led a study in 2009 in which a control group received a sham surgery while the experimental group received one of the three trigger point inhibition surgeries previously described. In this study it was found that 57% of the treatment group reported complete elimination of migraine headaches as compared to only 4% of the sham surgery group. As with all surgery there are potential complications including unfavorable scarring, bleeding, infection, facial nerve injury, blood clots, numbness, and intense itching. Patients in the five-year follow-up study reported side effects including skin numbness, hypersensitivity, hyposensitivity, and mild neck weakness or stiffness as well as occasional itching. Neurologist Dr. Jack Schim, of the Headache Center of Southern California, explained that patients with chronic migraines often suffer from terrible headaches, and are desperate for relief, but he believes that facial surgery should only be used as a last resort, and not as a first line of treatment for migraines. Dr. Schim noted that there are many alternatives to this surgery including multiple oral medicines, nerve blocks, and Botox injections. According to Dr. Schim 70% to 75% of patients experience significant reduction or complete elimination of headache symptoms from botox injections a result similar to the more invasive surgery. “If someone has tried everything, including avoiding medicine overuse, and addressed their lifestyle issues that could help or hinder headache problems, I would talk to the patient [about this] as an option,” said Schim.