ANA Discussion Forum
Post-Treatment => Headaches => Topic started by: ppearl214 on August 04, 2009, 02:35:52 pm
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FYI report of interest,
Phyl
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http://www.cnn.com/2009/HEALTH/08/04/migraine.surgery/index.html
STORY HIGHLIGHTS
Migraine patients who responded to Botox on a trigger point were enrolled in study
Patients were given real surgery to deactivate trigger point or sham surgery
57 percent of patients who had actual surgery said migraines were eliminated
Some patients who got sham surgery reported improvements as well
Facial surgery that targets and removes small portions of migraine-triggering muscle or nerve tissue may offer permanent relief for some people with the debilitating headaches, a new study suggests.
"Other migraine treatments either temporarily prevent the symptoms or they may reduce the symptoms after the migraine headaches start," says Bahman Guyuron, M.D., a professor and the chair of the department of plastic surgery at the University Hospitals of Cleveland and Case Western Reserve University. "What we are offering is essentially a cure."
In a study published in Plastic and Reconstructive Surgery, Guyuron and colleagues looked for people who had migraines that started in a specific region on the front, side, or back of the head. The researchers injected Botox into these trigger points to temporarily paralyze the muscle; if the injections helped relieve the migraines, the patients were randomly divided into two surgical groups.
After the Botox wore off, one group had a face-lifting surgery combined with the removal of muscle tissue or nerves in the area that triggered the migraines. Fat or muscle was used to fill in the area after tissue was removed.
The second group had a sham procedure, in which incisions were made but all muscles and nerves remained intact. A total of 75 patients were involved in the study.
In the year after the procedure, 57 percent of those who had the actual surgery reported the complete elimination of migraine headaches, compared with just 4 percent in the sham surgery group. In addition, 84 percent of those who had the surgery reported at least a 50 percent reduction in migraine pain compared with just 58 percent in the sham group.
As for side effects, one surgery patient had persistent numbness of the forehead, and 10 of 19 patients who had the procedure on the side of the head had a slight but persistent hollowing in their temple region.
More than 30 million Americans experience migraine headaches. However, Robert Kunkel, M.D., a consultant at the department of neurology at the Cleveland Clinic, says this surgery probably won't become a common procedure, despite the results.
"This may be a technique that will help a small number of migraine patients who have responded to Botox, but it's certainly not a procedure for generally treating migraines," says Kunkel, who was not involved in the new study. He points out that people who had the sham surgery probably suspected that they were in the placebo group, since the face-lift would most likely have reduced wrinkling. If a treatment isn't completely blinded, it can skew a study's results; if patients suspect they've had a sham treatment, they may be less likely to say their migraines are cured.
However, nearly 60 percent of the people who had the sham procedure reported some migraine relief too. Guyuron believes this could be related to a placebo effect, or the incisions could have disturbed some of the nerve branches and actually relieved migraines in some way.
Overall, there was a 92 percent success rate, notes Guyuron. "This study offers powerful evidence to the plastic surgeon, the neurologist, and the insurance companies that this operation is effective," he says. "Not only are they headache free, depending on the trigger site, but they also may look younger."
The Migraine Foundation, the Plastic Surgery Education Fund, and the Prentiss Foundation funded this study. Some of the study coauthors have consulted for Allergan or have been paid speakers for pharmaceutical companies.
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Phyl ~
Thanks for posting this report. The numbers are impressive and it certainly is encouraging for chronic headache sufferers. I would have to consider this a breakthrough. Whatever the statistical anomalies, the surgery should be considered as an option for at least some migraine headache sufferers.
Jim
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Thanks Phyl for posting this article.
This sounds similar to the surgery I had by Dr Ducic at Georgetown University Hospital. Here is a synopsis of his study of 206 patients with migraines caused by occipital neuralgia. No cosmetic component!
http://www.ncbi.nlm.nih.gov/pubmed/19407615?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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Glad you all enjoyed the read. I was recently diagnosed with 3 different kinds of migraines but haven't tried the botox yet (have read of others here on the forums that have tried it..... .and have a few forehead wrinkles I'd like to rid :D ). I am due to see my headache clinic in the next month, so will have to ask her about this.....
Janet, how are you doing now with the procedure you had done?
Phyl
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Hi Phyl,
You always have such good information to share. Thanks for the post. I also suffer from migraines. Mine are periodically but when I get them, they are pretty bad, and need to take migraine pills. Sometimes they don't work.
Vivian
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Vivian, glad to share info that may be of value to others here on the site. Like you, prescribed meds (I started a thread in this forum about Indomethicin as my headache clinic prescribed it for me....) Like you, sometimes the meds work, sometimes they don't. Just hate when they hit with a vengence to them.......
Hang in there!
Phyl
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Good on ya Phyl.
I am considering doing something following Janet's procedure but still very nervous about going under the knife again.
laz
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Janet, I'm just wondering if your procedures were covered by your insurance. I looked on the Cleveland surgeons website and his surgery for this condition is NOT covered by any insurance (yet.)
Capt Deb
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Here's another link on the surgery done by Janet's Dr Ducic:
http://www.ncbi.nlm.nih.gov/pubmed/19407615?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/pubmed/19407615?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)
Wonder what the chances are of getting in someone's clinical trial, eg the surgery at a reduced rate?
Capt Deb
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Here's another doc in Houston who has had success with the surgery:
http://abcnews.go.com/GMA/OnCall/story?id=3460798&page=1 (http://abcnews.go.com/GMA/OnCall/story?id=3460798&page=1)
also on this page are posts from fellow sufferers and some of her patients.
Capt Deb
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HEY! I just saw Dr Guyuron do a segment on ABC's "The Doctors." In it he explained a lot about migraines and his surgery. He focused on the forehead surgery he does. Most of my migraines start in the occipital/neck area, but they end up with forehead and eye pain. I'm having one right now, in fact. Oddly enough it is on the opposite side from my surgery for a change.
Think I'll go back to bed.......
Capt Deb(http://i235.photobucket.com/albums/ee60/Captdeb_photos/yohohoho-1.jpg)
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Re: In answer to Deb's question asking if my insurance covered occipital nerve surgery.
Yes. I had 2 surgeries. Both were covered at 100%. (One, I had to fullfill $124 of a deductible.) No referral was needed. I have Regency/Traditional which is part of Blue Shield. Even though I traveled across the US it was still considered network.
I used frequent flyer miles and stayed at a friends house to recover. The hotel at Georgetown University was very reasonable and I only stayed there the night before.