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Debated Surgical Procedure Provides Migraine Relief in Small Study

In a small recent study at Massachusetts General Hospital, a controversial surgical procedure for migraine treatment provided significant benefit for patients.

Thirty-five patients with chronic migraine who had not been helped by preventive medications were selected for the surgery, which proponents say deactivates migraine trigger sites. Each of the patients  had a history of nerve compression headaches and had experienced relief previously with Botox or nerve blocks. The surgeon released frontal, temporal, and occipital migraine headache trigger points, totaling 43 procedures on the 35 patients.

Bahman Guyuron, MD, developed this surgery more than a decade ago and frequently uses an endoscope to complete the procedure. In this study, an endoscope was not used. Instead, the surgeons, who were from Massachusetts General Hospital, Harvard Medical School, and Louisiana State University Sciences Center (New Orleans School of Medicine), made incisions in the upper eyelid. The authors said this approach has several benefits, including its use by surgeons without access to an endoscope or experience using one—and it provides cosmetic surgery by lifting the upper lid.

The overall positive response rate was 90.7%. More than 51% of the patients reported total elimination of their migraine headaches. More than 20% reported more than an 80% resolution of symptoms, and more than 28% reported a 50 to 80% reduction of headaches. Slightly more than 9% of patients indicated the surgery provided no significant effect. There were no major adverse events.

The authors concluded that the surgery is a safe and effective treatment in select migraine headache patients. They plan to study these patients prospectively to improve patient selection and refine their protocol.

Arthur Elkind, MD, the President of the National Headache Foundation, noted that while this procedure has been controversial among neurologists and headache specialists, the fact that these positive study results came from a leading hospital adds credibility to the surgery.

“We await longer term follow-up information on the outcome and duplication at other medical centers,” Dr. Elkind said.

The lead researcher of the study was Lisa Gfrefer, MD, of Massachusetts General Hospital. The article appeared in the journal Plastic and Reconstructive Surgery.

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