HeadWise HeadWise: Volume 2, Issue | Page 16

( Botox ® ) as a migraine treatment for several years . An extensively modified protocol of the kind used in cosmetics was approved by the FDA for treatment of chronic migraine in 2010 . Patients who undergo the treatment generally receive injections every 12 weeks around the head and neck to dull the symptoms of the migraine , according to the FDA ’ s 2010 press release .
To qualify for Dr . Guyuron ’ s plastic surgery study , patients had to first respond well to Botox for migraine relief ; he found 76 patients who met the requirements . Dr . Guyuron theorized that those who responded well to Botox would find more permanent relief through surgery . It should be noted that , when used for migraine treatment , neither procedure is used to change the patient ’ s looks ; instead , the
techniques are applied to migraine trigger points in an attempt to relieve pain .
In the case of Dr . Guyuron ’ s outpatient procedure , a surgeon incises through the skin into the areas of fibrous tissue through which nerves run . Specifically , the surgeon looks for either scarring of nerves or nerves trapped in muscle in three trigger sites ( the forehead , temples or back of the head ). If the nerves or muscles seem to be to blame for the migraine pain , the surgeon surgically deactivates the trigger site in question by removing any excess muscle and injecting fat to cushion the nerves and fill any pockets left from the removal of the muscle . The whole thing takes less than an hour .
The 76 patients in Dr . Guyuron ’ s study were divided into three groups
( based on the trigger sites ). In each group , two-thirds of the patients underwent surgery to deactivate muscles . The other one-third of patients in each group underwent “ sham surgery ” in which the surgeon made incisions to expose the muscles but did not deactivate them . The results were positive : 15 of the 26 in the sham surgery group and 41 of the 49 people in the actual surgery group reported at least a 50 percent reduction in migraines for one year after the surgery . Of the 41 in the actual surgery group who reported a reduction , 28 said their migraines had been completely eliminated .
DOWNFALLS OF THE STUDY
Positive results aside , headache specialists have reservations about
To learn about the history of migraine treatments , read Headache Through the Ages by Seymour Diamond , MD , and Mary A . Franklin ( Professional Communications , Inc ., 2005 ), available on Amazon . com .
recommending plastic surgery based on Dr . Guyuron ’ s study alone . For one thing , the way the study was devised might lead to a false assumption , says Mark Green , MD , director of the Center for Headache and Pain Medicine at the Mount Sinai School of Medicine in New York City , and an NHF Board member . It is unclear whether Botox affects migraine by paralyzing muscles or inhibiting nerves that transmit pain signals to
the brain . If researchers don ’ t believe that Botox works by paralyzing muscles , “ then why are we operating and cutting muscles through plastic surgery ?” Dr . Green wonders , adding that the assumption that Botox and plastic surgery could have similar effects needs further investigation . Even though the plastic surgery did have a positive impact on patients in Dr . Guyuron ’ s study , data that show the effects of the surgery
over time do not yet exist . Without long-term data , “ you end up with a lot of anecdotal information , and that ’ s where problems can occur ,” says Roger Cady , MD , associate executive chairman of the National Headache Foundation

Discarded Migraine Treatments

By Seymour Diamond , MD , Executive Chairman and Founder of the National Headache Foundation ( NHF )
������������������������������������������������������������������������������������������������������������������ Wolff discovered that the use of ergot ( a fungus that grows on rye ) could successfully treat acute migraine attacks , that a recognized effective therapy was identified . Since that discovery , we have seen a proliferation of effective pro- ��������������������������������������������������Headache , my late friend J . N . Blau noted that “ only charlatans claim a cure for migraine , and the majority of patients appreciate [ that ] a cure is unattainable with our present knowledge .”
From the earliest times , focal treatment to the head or neck during a migraine attack was advised . John Fordyce ( who published De Hemicrania ����������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������������������� ����������������������������Willis ’ Practice of Physick , Being the Whole Works of that Renowned and Famous Physician , blood-letting was suggested as an acute headache treatment .
���������������������������������������������������������������������������������������������������������������������� this treatment in two plays :
������King John�������������������������������������������������������������������� When your head did but ache , I knit my handercher about your brows
������Othello , Act III , Scene 2 , in a dialogue between Othello and Desdemona : Desdemona : Why do you speak so faintly ? Are you not well ? Othello : I have a pain upon my forehead here . Desdemona : ‘ Faith , that ’ s with watching ; ‘ twill away again : Let me but bind it hard , within this hour .’ It will be well .
����������������������������������������������������������������� if hot applications to the head failed , the tender blood vessels in the temple should be severed and the wound dressed with garlic . Trephining , which involved making a burr hole in ����������������������������������������������������������������� I continued to see recommendations for its use , and publicity ������������������������������������������
In many cases , both prophylactic and acute treatments have not been subject to rigid scrutiny . Whatever studies were done , they were not replicated and merely afforded the opportunity for expensive and minimally effective help . As an example , I would cite repairs of the patent foramen ovale ( a congenital hole between the chambers of the heart ) and its alleged relationship to migraine . This condition may be persistent throughout life . Some studies , reportedly demonstrating these interventions to be effective , have been associated with a grandiose public relations campaign . With such a long history of discarded therapies , migraineurs should be wary of any pronouncement of a treatment that claims to be a cure-all for their headaches .
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