HeadWise HeadWise: Volume 2, Issue - Page 30

(Botox®) as a migraine treatment for several years. An extensively modified protocol of the kind used in cosmetics was approved by the FDA for treatment of chronic migraine in 2010. Patients who undergo the treatment generally receive injections every 12 weeks around the head and neck to dull the symptoms of the migraine, according to the FDA’s 2010 press release. To qualify for Dr. Guyuron’s plastic surgery study, patients had to first respond well to Botox for migraine relief; he found 76 patients who met the requirements. Dr. Guyuron theorized that those who responded well to Botox would find more permanent relief through surgery. It should be noted that, when used for migraine treatment, neither procedure is used to change the patient’s looks; instead, the techniques are applied to migraine trigger points in an attempt to relieve pain. In the case of Dr. Guyuron’s outpatient procedure, a surgeon incises through the skin into the areas of fibrous tissue through which nerves run. Specifically, the surgeon looks for either scarring of nerves or nerves trapped in muscle in three trigger sites (the forehead, temples or back of the head). If the nerves or muscles seem to be to blame for the migraine pain, the surgeon surgically deactivates the trigger site in question by removing any excess muscle and injecting fat to cushion the nerves and fill any pockets left from the removal of the muscle. The whole thing takes less than an hour. The 76 patients in Dr. Guyuron’s study were divided into three groups (based on the trigger sites). In each group, two-thirds of the patients underwent surgery to deactivate muscles. The other one-third of patients in each group underwent “sham surgery” in which the surgeon made incisions to expose the muscles but did not deactivate them. The results were positive: 15 of the 26 in the sham surgery group and 41 of the 49 people in the actual surgery group reported at least a 50 percent reduction in migraines for one year after the surgery. Of the 41 in the actual surgery group who reported a reduction, 28 said their migraines had been completely eliminated. DOWNFALLS OF THE STUDY To learn about the history of migraine treatments, read Headache Through the Ages by Seymour Diamond, MD, and Mary A. Franklin (Professional Communications, Inc., 2005), available on Amazon.com. Positive results aside, headache specialists have reservations about recommending plastic surgery based on Dr. Guyuron’s study alone. For one thing, the way the study was devised might lead to a false assumption, says Mark Green, MD, director of the Center for Headache and Pain Medicine at the Mount Sinai School of Medicine in New York City, and an NHF Board member. It is unclear whether Botox affects migraine by paralyzing muscles or inhibiting nerves that transmit pain signals to the brain. If researchers don’t believe that Botox works by paralyzing muscles, “then why are we operating and cutting muscles through plastic surgery?” Dr. Green wonders, adding that the assumption that Botox a \X\\H[]H[Z[\YXYY\\[\Y][ۋ][YH\X\\HY]HH]]H[\Xۈ]Y[[^]\۸&\YK]H]HYXوH\B\Hݙ\[YHY]^\ ]]ۙ]\H]K8'[H[\]Hو[X[[ܛX][ۋ[]8&\\H؛[\[\8'H^\\YKQ \X]H^X]]HZ\X[وH][ۘ[XYXH[][ۂ\\YZYܘZ[HX]Y[H^[[\X[[ۙ Q ^X]]HZ\X[[[\وH][ۘ[XYXH[][ۈ HY\X][ۜHXYZ[Y H[\\[[H[\H[H]\Y[H[\Y]\Xˈ\[[X[YXZ[H\H[H۝[YYYHX[Y[][ۜ܈]\K[XX]H\ݙ\Y]H\Hو\ H[\]ܛۈYJH[X\ٝ[HX]X]HZYܘZ[H]X]HXۚ^YYX]H\\H\Y[YYY [H]\ݙ\KH]HY[HY\][ۈوYX]HXYXK^H]HY[]HY]8'ۛH\][Z[HH\H܈ZYܘZ[K[HXZܚ]Hو]Y[\XX]H]HH\H\[]Z[XH]\\[ۛYK'HHHX\Y\[Y\[X]Y[HXY܈X\[HZYܘZ[H]X\Y\Y ܙXH X\YH[ZXܘ[XH[\&HXXHو\XZ[HHܚو][ۙY[[[\\XX[ [][\Y\Y\[X]HXYXHX]Y[ \X]Y[[^\Έ[[[\XYY]XKHۚ]^H[\\X][\[XRRK[H [HX[YH]Y[[[\[[ۘN\[[ۘNH[HXZZ[O\H[H[[ΈH]HHZ[\ۈ^HܙZXY\K\[[ۘN8&Z] ]8&\]][8&[]^HYZ[]YH][]\ ][\\&H][H[ [X[H\\[XX[X]HX]Y[]HY[XXYYܝ][K]]\YY\\HۙK^H\H\X]Y[Y\[HYܙYHܝ[]H܈^[]H[Z[[X[HYX]H[ \[^[\KH[]H\Z\وH][ܘ[Y[ݘ[H Hۙ[][H]Y[H[X\وHX\ H[][YY[][ۜ\ZYܘZ[K\ۙ][ۈX^HH\\[Y]YKYHYY\\ܝYH[[ۜ][\H[\[[ۜHYX]K]HY[\X]Y]Hܘ[[HXX[][ۜ[\ZYۋ]XHۙ\ܞHو\\Y\\Y\ZYܘZ[]\[H\Hو[Hۛ[[Y[وHX]Y[]Z[\HH\KX[܈Z\XYX\˂̂˚XYX\˛ܙ‚][ۘ[XYXH[][ۂ‚