Doctors Debate the Effectiveness of Migraine Plastic Surgery

July 23, 2013

Can you imagine high drama at a headache convention? Perhaps that is a slight exaggeration of the spirited migraine plastic surgery debate that took place in Boston recently at the 2013 International Headache Congress. 

This procedure for migraines is a relatively new and controversial migraine treatment. Presenting on one side of the debate was a surgeon from Cleveland who explained the benefits and mechanism of this procedure.  On the opposing side of the issue, was a skeptical neurologist from Germany, who appeared to have won the argument by the end of the discussion, based on a vote taken of the audience.

The surgeon explained that migraine plastic surgery helps migraine patients by decompressing the nerves at pressure points, pre-identified by injecting Botox into the sites.  If these injections succeed in abating migraines temporarily, then he will proceed with the surgical procedure, which involves cutting the nerves. 

As a practicing cosmetic surgeon, he came upon this migraine treatment when he performed browlift procedures on two patients who reported being pleasantly surprised that their migraines had vanished along with their wrinkles.  He conducted controlled trials with sham surgeries on individuals with migraines and found 57 percent of the subjects who received the ‘real’ surgery no longer experienced headaches compared with 4 percent in the control group

Because the studies were not published in neurology journals, and the patients received Botox injections prior to the surgeries, the specialist from Germany was skeptical of the research results.  He noted that Botox is only effective for chronic migraine sufferers, and that the patients chosen for the study, who claimed that Botox alleviated their headaches, had episodic migraine. 

This was significant because it suggested that the patients were inclined to respond to placebo migraine treatment, and this would account for the high positive response rate to the migraine plastic surgery.

By the end of the debate at the International Headache Congress, co-hosted by the American Headache Society and The International Headache Society, it appeared that everyone agreed at least on one fact: that more research would be helpful.


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