Migraines are difficult treatment problems that are resistant to many standard drug therapies. Few migraine sufferers have one treatment approach that works consistently. Migraines that have a single or predominant trigger site, while is just a subset of migraine sufferers, have been undergoing novel non-surgical (Botox) and surgical (nerve decompression) treatments in some centers with fairly high rates of relief.
In a recent paper in the August 2009 issue of Plastic and Reconstructive Surgery, plastic surgeons from the Cleveland Clinic report on their experience with the surgical treatment of migraine headaches. Seventy-five (75) patients with moderate to severe headaches were studied who had a prior positive response to Botox injection therapy. Frontal, temporal and occipital trigger sites were identified and the patients were assigned to receive either actual or sham surgery on their predominant trigger site. Of the 75 patients, 58% in the sham group and 84% in the actual surgery group experienced at least 50% reduction in their migraine headaches. In the surgery group, 57% reported complete elimination of their migraine pain compared to just 4% in the sham group.
This reported study is one of, if not the most significant, clinical study ever performed in evaluating the relatively new surgical decompression techniques of external migraine trigger points. Being actually able to perform sham surgery on patients seems like a throwback from years ago and is a credit to the authors to having gotten this through their institutional IRB. Because of this study’s design, the outcomes are fairly convincing that surgical deactivation of peripheral migraine trigger sites works….even if the mechanism of its effects is not completely understood yet. While there was a significant response rate in the sham group, few complete migraine eliminations were recorded unlike the actual surgery group.
No one knows exactly why migraines occur and many theories have been proposed. Surgical decompression of external migraine trigger points that course through cervicofacial muscles is based on the premise that peripheral nerve activation results in central brain sensitization. For some migraine patients, this published work and their previously reported studies provide solid evidence that this concept has merit.
Any potential patient reading this study should not necessarily assume that they are good candidates for these procedures. Patients should be thoroughly evaluated by a neurologist and have other causes for their migraines evaluated. Their migraine headache should be classified and, if appropriate, the effects of Botox on the trigger points should be done. Only if Botox injections produce significant relief should surgical nerve decompression of the trigger point be considered.
Dr. Barry Eppley