Surgical Treatment of Migraine Headaches by Corrugator Muscle Resection

Department of Plastic Surgery, Wilhelminenspital, Vienna, Austria.
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 10/2004; 114(3):652-7; discussion 658-9. DOI: 10.1097/01.PRS.0000131906.27281.17
Source: PubMed


The authors, a plastic surgeon (Dirnberger) and a neurologist (Becker), conducted this study after reading the article by of Bahman Guyuron et al. in the August 2000 issue of Plastic and Reconstructive Surgery (106: 429, 2000). Sixty patients were operated on between June of 2001 and June of 2002; postoperative follow-up ranged between 6 and 18 months. Patients' charts were reviewed to confirm the diagnosis of migraine headache according to the criteria of the International Headache Society. Sixty patients (13 men and 47 women) from Austria and four neighboring countries took part in the study. The patients were divided into three groups, based on the severity of their migraines: group A comprised patients with up to 4 days of migraine per month; group B included patients with 5 to 14 days of migraine per month; and group C was composed of patients with more than 15 days of headache per month ("permanent headache") or evidence of drug abuse and drug-related headaches. The effectiveness of the operation was evaluated using the following factors: percentage reduction of headache days; percentage reduction of drugs; percentage reduction of side effects, severity of headaches, and response to drugs; and patient grade of personal satisfaction, using a scale from 1 to 5 [1 = excellent (total elimination of migraine headache) to 5 = insufficient or no improvement]. From the entire group of 60 patients, 17 (28.3 percent) reported a total relief from migraine, 24 (40 percent) reported an essential improvement, and 19 (31.7 percent) reported minimal or no change. Patients with a rather mild form of migraine headache had a much better chance (almost 90 percent in group A and 75 percent in group B) to experience an improvement or total elimination of migraine than those patients (n = 27) from group C with severe migraine, "permanent headaches," and drug-induced headaches. Contrary to the reports by Guyuron, 11 patients who had a very favorable response immediately and in the first weeks after the operation experienced a gradual return of their headaches to preoperative intensity after about 4 postoperative weeks. After 3 months, the results in all patients could be declared permanent. All side effects, such as paraesthesia in the frontal region, disappeared in all patients within 3 to 9 months.

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    • "Surgical deactivation of migraine trigger sites as well as preoperative botulinum toxin injection has been proven effective for the treatment of severe MH (9-13). Based on the “trigger point” hypothesis of migraine pathogenesis, plastic surgeons introduced the use of botulinumtoxin and nerve blocks as a diagnostic adjunct and predictor of responsiveness for migraine surgery. "
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    ABSTRACT: Based on the conducted anatomic studies at our institutions as well as clinical experience with migraine surgery, we have refined our onobotulinumtoxin A (BOTOX®) injection techniques. Pain management physicians are in unique position to be able to not only treat migraine patient, but also to be able to collaborate with neurologists and peripheral nerve surgeons in identifying the migraine trigger sites prior to surgical deactivation. The constellation of migraine symptoms that aid in identifying the migraine trigger sites, the potential pathophysiology of each trigger site, the effective methods of botulinumtoxin and nerve block injection for diagnostic and treatment purposes, as well as the pitfalls and potential complications, will be addressed and discussed in this paper.
    Anesthesiology and Pain Medicine 07/2012; 2(1):5-11. DOI:10.5812/aapm.6286
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    ABSTRACT: To describe our results with botulinum toxin type A injection for headache in carefully selected patients, and to present the rationale behind this therapy. Tertiary referral centre. This article describes a case series of 10 consecutive patients with frontally localised headache, whose pain worsened when pressure was applied at the orbital rim near the supratrochlear nerve. The patients received a local anaesthetic nerve block with Xylocaine 2 per cent at this site. If this reduced the pain, they were then offered treatment with botulinum toxin. Injection with 12.5 IU of botulinum toxin A into the corrugator supercilii muscle on both sides (a total of 25 IU). Pain severity scoring by the patients, ranging from zero (no pain) to 10 (severe pain) on a verbal scale. Following injection, all patients had less pain for approximately two months. This treatment did not appear to have lasting side effects. Xylocaine injection is a good predictor of the effectiveness of botulinum toxin injection into the corrugator muscle as treatment of frontally localised headache. We hypothesise that this pain is caused by entrapment of the supratrochlearis nerve in the corrugator muscle. Furthermore, we found botulinum toxin injection to be a safe and effective means of achieving pain relief in this patient group.
    The Journal of Laryngology & Otology 07/2008; 123(4):412-7. DOI:10.1017/S0022215108003198 · 0.67 Impact Factor
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