Assessing the Efficacy of Migraine Surgery

Assessing the Efficacy of Migraine Surgery

A broad series of studies by the Case Western Reserve University School of Medicine suggests that surgery may be effective in treating many patients who suffer from migraines.

Forehead rejuvenation is a procedure in the frontal region that includes the removal of undesired frowning muscles. Foraminotomy — which is the removal of the supraorbital and supratrochlear arteries — and fasciotomy may be performed as additional procedures if suggested by the symptomatology and pathology.

Ÿ In a retrospective study, of the 249 patients, 39 confirmed having MH prior to the surgery, and 31 (P <.0001) reported either total elimination or significant improvement (at least 50% reduction) of their MH.

Ÿ In a prospective pilot study, 21 of the 22 patients reported a significant improvement (P <.001).

Ÿ In a prospective randomized study, 82 of 89 (92%) observed at least 50% improvement in the frequency, intensity, and duration of migraines (P <.00001). Also, 61 of 69 (88%) patients who were followed for 5 years continued to have significant improvement (P <.0001).

Ÿ In a randomized study that involved sham surgery, 21 of the 49 (83%) patients benefitted from the real surgery compared to 15 of 26 (56%) patients in the placebo group (P 5.014). Furthermore, 28 (57%) patients in the real surgery group reported total elimination of migraines, while only 1 patient in the sham surgery group reported elimination (P <.0001).

The origin of surgery to treat migraines began in 1999, when plastic surgeons were performing forehead rejuvenation surgery for cosmetic purposes. Patients started reporting that their migraines were being eliminated after undergoing the procedure. Because neither the patients nor the surgeons were expecting this effect from the surgery, the idea that the disappearance of migraines was a placebo effect began to be discredited.

A study by Case Western Reserve University2 may help explain why surgery is effective in migraine patients. Researchers compared nerve segments of migraine sufferers to those of non-migraine sufferers, who were undergoing forehead rejuvenation cosmetic surgery, using proteomic analysis and electron microscopy. What they found was the following:

Differentially expressed proteins and networks comprised of highly connected molecular modules (P values of 10-34 and 10-34) on patients with migraines were identified. The nerves of patients with migraine had a linear organization, disrupted myelin sheaths and target axons, and discontinuous neurofilaments that were poorly registered with the discontinuous myelin sheaths, which suggested axonal pathology, the study stated.

In other words, patients who suffer from migraines may have myelin deficiency, and vulnerable nerves could be irritated peripherally and thus begin the process that eventually results in the full migraine complex, the researchers suggested. They went on to state that the study reinforces the role of peripheral mechanisms in migraines and provides a probable explanation of why surgery and onabot may work, without diminishing the role of central mechanisms.

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