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Forehead lift smooths some patients' headaches, too

Migraines lessen or disappear after the surgery, but doctors wonder whether the results would hold true for the larger population.

August 10, 2009|Shara Yurkiewicz

Looking for another reason why you "need" a forehead lift? The surgery seems to eliminate or reduce pain of migraines.

In a double-blind study by Case Western Reserve University researchers, patients with frequent moderate to severe migraine headaches with pain radiating from a single region were treated surgically -- with excellent results.

Botox injections to the forehead, neck or shoulders have already been shown to help some people who suffer from migraines, possibly by relaxing key muscles. But the pain eventually comes back. In this study, published in Plastic and Reconstructive Surgery, doctors were seeking a more permanent solution via plastic surgery.

They first injected patients with Botox to determine the location of the trigger site for each person's migraine: the forehead, temple or back of the head.

Those who reported fewer migraine symptoms upon injection with Botox were selected for surgery to deactivate the trigger site in a procedure similar to that of a forehead lift.

In the study, 76 patients were assigned randomly to undergo either a sham surgery (the control group) or an actual operation. Unaware of which they had received, patients recorded frequency, intensity and duration of headaches for 12 months.

The researchers found that 28 of 49 patients (57.1%) in the group that had surgery reported elimination of migraine headaches at the end of a year, compared with just 1 of 26 (3.8%) who had fake surgery.

Forty-one of 49 patients (83.7%) in the surgery group had significant improvement in migraine frequency, intensity and duration, compared with 15 of 26 (57.7%) of the controls.

"This is an outpatient operation," said study coauthor Dr. Bahman Guyuron, a plastic surgeon at University Hospitals Case Medical Center in Cleveland. "Patients go home right away after surgery and are back to work in about a week."

And he added, "We're not introducing the surgery for cosmetic reasons. But this is more of a reason to have the surgery if a patient is [already] thinking about cosmetic surgery."

The study has raised some eyebrows among other physicians, however.

Dr. Sheena Aurora, director of the Swedish Headache Center in Seattle, said she wondered whether the observed effects might have been caused at least in part by the Botox, not the surgery alone.

"It seems a bit too good to be true," said Dr. William Young, an associate professor of neurology at Thomas Jefferson University and director of the inpatient program at the Jefferson Headache Center. "For migraines, these results are unheard of from any treatment, anywhere."

Young wonders whether the patients truly remained in the dark about whether they'd received real or fake surgery: If they didn't, the results could have been confounded by a placebo effect -- in other words, people who knew they'd had the procedure may have more readily believed that they had improved. "Somehow, patients can know whether they got the real treatment or not," Young said.

Another issue is whether these results would be generalizable to migraine patients at large, said Young's colleague Dr. Michael Marmura, an assistant professor of neurology at Thomas Jefferson University. In this study, "only patients with an excellent response to small doses to Botox injections were included," he said. "Basically . . . these are not typical patients."

"I think they did a meticulous job of patient selection," said Dr. Richard Lipton, a professor and vice chairman of neurology at Albert Einstein College of Medicine and director of the Montefiore Headache Center. "But because the patients were so carefully selected, the results don't apply to everyone. They only apply to a subgroup of migraine sufferers with identified triggers and a demonstrated response to Botox.

"There's a lot of natural skepticism for things that are new," Lipton added. "I think it's really exciting and would love to see it replicated."

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shara.yurkiewicz@latimes.com

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