Years ago, dealing with a migraine meant hours—or days—of incapacitation. You fussed with drugs that hardly worked, relied on iffy folk remedies and whiled away hours in a dark, quiet space while the migraine ran its course. Nowadays, a cornucopia of remedies is at our disposal. And yet, some people still don’t find relief. But a surprising sort of surgery, pioneered by plastic surgeons, may be an option.
A NIP AND TUCK FOR MIGRAINE?
Did you know that brow lifts can relieve migraine symptoms? In fact, they can relieve migraine headaches in certain people permanently. What’s more, the field of plastic surgery has been spear-heading advances in migraine relief for years. Botox, a neuromuscular relaxer that temporarily wipes away age lines, can relieve chronic migraine symptoms for three to four months when injected into muscles in the head where migraine pain starts.
And for nearly 15 years now, surgeons have been performing a procedure that, in part, involves making cuts in the forehead and temples near the hairline (similar to a brow lift) to relieve migraines. Using an endoscope, a tubelike device with a tiny camera and snippers attached to it, the surgeon finds and removes certain muscles in the brow and temples to relieve pressure on nerves responsible for migraine. (Cuts also may be made at the back of the head to relieve migraine triggers that start there, but an endoscope is not needed to reach them.) About 57% of people who have this procedure no longer have migraines, and more than 80% get significant and lasting improvement in migraine symptoms.
But not everyone who can be helped by this type of surgery is a good candidate for it. These include people who don’t have good hairlines in which to hide the incision scars (those with long foreheads, high hairlines, thinning hair or who are bald).
To see whether an alternative, nonendoscopic technique could get the same results as the migraine surgery technique inspired by a brow lift, plastic surgeons from Massachusetts General Hospital accessed muscles and nerves in the forehead and temple via blepharoplasty—the approach used for eye lift surgery. The surgical incision is made through the upper eyelid, and a small amount of excess skin and fat is removed to get at the muscles and nerves.
Researchers performed this nonendoscopic migraine surgery in 35 patients who had previously responded to nerve block or Botox therapy (which confirmed that their migraines were caused by compression of nerves in their skulls). A year after surgery, patients filled out questionnaires to provide feedback on how well the surgery had relieved migraine pain. And results were impressive. Fifty-one percent said that surgery completely wiped out migraine symptoms, and 21% said that they got nearly complete relief. Twenty-eight percent of patients reported getting at least 50% relief of migraine symptoms.
An advantage of the upper-eyelid approach is that patients treated for migraine triggers in the forehead and temple are left with a single unnoticeable scar on the upper lid instead of several scars from the series of cuts made along the hairline during endoscopic surgery. So, the upper-eyelid approach may be an option for people who, for whatever reason, can’t hide a surgical scar in a hairline.
Complete recovery time for the nonendoscopic procedure was the same as for endoscopic surgery—about two weeks. The nonendoscopic procedure also was relatively safe as surgery goes—at least in this one study of 35 people. No major adverse events were reported, although two patients were left with permanent numb spots at surgical incisions they received for migraine triggers at the backs of their heads.
Complications are also rare for endoscopic surgery—but make no mistake, surgery is never risk-free. Complications can include numbness, losing the ability to move eyebrows or forehead, scar formation and permanent hair loss where incision scars form.
For this reason, migraine surgery should be the last resort, reserved for people who have tried everything else with no relief, the study’s lead researcher, William G. Austen, Jr., MD, chief of plastic and reconstructive surgery at Massachusetts General Hospital, told me. After all, a 100% guarantee of migraine relief cannot be made.
THE BEST APPROACH
“If you can be treated with medications and/or lifestyle changes, you should do that,” Dr. Austen said. A person with chronic headache should not go first to a plastic surgeon for relief, he cautioned. Dr. Austen’s advice is to first consult a migraine specialist—a neurologist specializing in headache and chronic pain relief. The migraine specialist is in the best position to accurately diagnose migraine, uncover the cause of chronic headache and refer you to an experienced surgeon if surgery is right for you.