Surgical Treatment of Migraine Headaches by
Corrugator Muscle Resection
Franz Dirnberger, M.D., and Klaus Becker, M.D.
The authors, a plastic surgeon (Dirnberger) and a neu-
rologist (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 cri-
teria of the International Headache Society. Sixty patients
(13 men and 47 women) from Austria and four neigh-
boring 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 com-
posed 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 re-
duction 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 per-
cent) reported a total relief from migraine, 24 (40
percent) reported an essential improvement, and 19
(31.7 percent) reported minimal or no change. Pa-
tients 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 im-
provement 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.
114: 652, 2004.)
(Plast. Reconstr. Surg.
The article on the surgical treatment of mi-
graine headaches by Bahman Guyuron et al.1
in the August 2000 issue of the Journal gener-
ated great interest in the senior author (Dirn-
berger), as he not only is a plastic surgeon but
also has experienced migraine headaches for
the last 20 years. He decided immediately to
undergo this operation himself.
The operation was performed in February of
2001 and the result was striking. His migraine
attacks were reduced by about 80 percent in
frequency as well as severity. All side effects,
such as nausea and intolerance to noise, disap-
peared completely, and his quality of life had
practically returned to its premigraine era
To ensure that the effect of the intervention
was a lasting one, an observation period of 6
months was allowed to pass before it was de-
cided to commence treatment of other mi-
graine patients. Following publication of a
brief report in a newspaper, the interest of
migraine patients in the new treatment was
overwhelming, but it was decided to operate
only on patients with a history and symptoms of
migraine correlating to the standards of the
International Headache Society. The charts of
all patients were reviewed by a neurologist
(Becker); they were examined for various pa-
rameters, as shown in Table I.
PATIENTS AND METHODS
Between August of 2001 and July of 2002, 60
patients underwent surgical treatment for mi-
graine headaches. All had symptoms of classic
migraine according to the standards of the
May 15, 2003; revised September 19, 2003.
Provocation of migraine by trigger compression.
Two patients reported a remarkable phenom-
enon: the arousal of an acute migraine attack
after accidental compression of the trigger
zone. In one patient, we had marked the
course of the supratrochlear nerve by painting
a corresponding line on the skin, to explain it
to other patients. As this had been done with a
strongly adherent ink, quite heavy pressure
and rubbing were necessary to remove the line.
Thus the patient involuntarily massaged the
underlying nerve. The patient, who had been
free of any migraine for 2 months, called about
1 hour later and reported that she experienced
a severe migraine attack, like those she had
experienced before the operation.
Another patient told us a similar story. Some-
one recommended that he softly massage the
scars at the upper eyelid to get them to mature
faster, and anytime he did this, he also experi-
enced some kind of mild migraine. These re-
ports conform the suspicion that compression
of the supratrochlear nerve might play an es-
sential role in provoking a migraine attack.
After the first report by Guyuron et al.,1our
expectations for this new migraine treatment
were high. Almost 2 years later and after more
than 100 patients have been operated on (the
first 60 are included in this report), we are
convinced that this operation is of real value
and will become an essential tool in the treat-
ment of this widespread malady. Because of the
large number of people who are affected by
migraines, this treatment has essential social
and economic effects. A reduction in the num-
ber of headache days means that people will be
able to stay on their jobs and get back their
pleasure in their private and social lives.
We had to realize that it is not easy to con-
vince our colleagues, especially neurologists,
that we have “accidentally” found a good
method for the treatment of this malaise. We
agree that there is good reason to distrust re-
ports of 80 percent cure rates. We still believe
that migraine is a neurological disease and that
it needs to be treated primarily by neurologists,
but plastic surgeons may become important
helpers for those patients who do not get sub-
stantial relief of their headaches after thor-
ough neurological treatment. We believe that
we do have a tool, but we still do not know why
and how it works; this naturally leaves some
Our observations confirm the opinion that
the corrugator muscle has a “trigger function,”
and that the compression of the supratrochlear
nerve is essential for the provocation of a mi-
graine attack. Our data show that there is a
distinct difference in the chance of responding
positively to the operation: the milder the mi-
graine headaches are, with regard to fre-
quency, duration, and amount of drugs
needed to suppress them, the better the
chances of improvement.
Since the operation has so far not caused any
serious complications or side effects, it can be
recommended to patients with severe forms of
migraine and symptoms of drug dependency.
These patients still have a 50 percent chance of
responding with partial or even total relief of
Franz Dirnberger, M.D.
Department of Plastic Surgery
1010 Vienna, Austria
1. Guyuron, B., Varghai, A., Michelow, B. J., Thomas, T.,
and Davis, J. Corrugator supercilii muscle resection
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Vol. 114, No. 3 / CORRUGATOR MUSCLE RESECTION