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.
    Full-text · Article · Jul 2012 · Anesthesiology and Pain Medicine
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    • "Of course, this also applies to one injection into the corrugator muscle alone. The surgical section of the corrugator muscle after the alleged response to a BTX injection must not be regarded as a therapeutic option for migraine [6] [7]. "
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    ABSTRACT: Botulinum toxin is a therapeutic option in chronic migraine. No dose-finding studies have been conducted so far. Some authors maintain that one injection into the corrugator muscle will do. Objective: We studied the effect of Botulinum toxin (BTX) injections in patients with strictly unilateral migraine. Methods: We treated 22 patients (ITT) in a crossover design for 4 months with 2 x 5 units Onabotulinum toxin (in the corrugator and occipitalis muscle ipsilaterally). Aside from patient data, we also gathered information on undesired drug effects, besides IQOLA SF36, SF-MPQ SADP, OLBPDQ, VAS (pain intensity and daily living skills), PPI, frequency of attacks and application of medication. The statistical evaluation was guided by SPSS (V.13). Results: Assessed were 19 patients (PP) aged 45.2 ± 11.1 years, thereof 17 women. In both injection intervals there were no clinically relevant and/or statistically significant differences as to the target parameters (for example: VAS pain intensity p=0.702), with a notably evident placebo effect (VAS in placebo prior to the injection was 61.4, after 6 weeks 45.1; good or excellent improvement (TOQ) was quoted by 36.8% after 6 weeks in the placebo group). BTX merely proved superior in two aspects: Regarding the pain quality "throbbing" (SF-MPQ SADP), 11 patients initially indicated a pronounced intensity; after BTX only 4 of them did. As to the severity of the pain felt, (PPI) 42.2 of the subjects described "limiting" or "horrible" pain prior to the injection versus 26.3% six weeks after the injection and 21.1% 4 months later. The placebo group started out with 31.6%, that figure remaining the same (31.6%) 6 weeks later, rising to 42.2% after 4 months. 84.2% of the BTX-group and 63.2% in the placebo group requested a reinjection when the study was completed. Conclusion: The injection of low-dosed Botulinumtoxin A did not show any relevant or significant effects in patients with unilateral migraine without aura. One injection into the corrugator muscle alone must be considered as ineffective. The place-value of the two injection sites remains in the open.
    Full-text · Article · Oct 2011 · The Open Pain Journal
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