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Skin Deep - Plastic Surgery That May Also Relieve Migraines - NYTimes.com
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By CATHERINE SAINT LOUISPublished: September 2, 2009 MANY of the nearly 30 million Americans who suffer from migraines end up feeling like guinea pigs. Chronic patients — those who are laid low 15 or more days a month — often cycle through drug after drug in search of relief. They also contend with side effects like mental sluggishness and stomach upset. Treatment involves guesswork because doctors have not pinpointed what causes migraines, nor do they know which drugs will best help which patients.
National Headache Foundation, a nonprofit organizationdevoted to patient education.
No wonder that last month, news of a surgical “cure” that MOST POPULAR
touts a high success rate ricocheted worldwide. The double-blind study, published in the journal Plastic and Reconstructive Surgery, found that more than 80 percent of patients who underwent surgery in one of three “trigger 3. Frank Rich: Even Glenn Beck Is Right Twice a Day sites” significantly reduced their number of headaches compared with more than 55 percent of the group who had 5. Belatedly, Egypt Spots Flaws in Wiping Out Pigs sham surgery. More than half of the patients with the real surgery reported a “complete elimination” of headaches compared with about 4 percent of the placebo group.
7. A Doctor for Disease, a Shaman for the Soul 8. Eager Students Fall Prey to Apartheid’s Legacy Forehead lifts are cosmetic procedures that plastic surgeons typically perform to smooth furrowed brows. But a decade ago, after some of his patients reported that their migraines improved post-operation, Dr. Bahman Guyuron, a plastic surgeon and the lead author of the study, began to search for a surgical solution that could address migraine trigger points Skin Deep - Plastic Surgery That May Also Relieve Migraines - NYTimes.com
— which he defines as where the headache begins and settles — in the forehead, templesand the back of the head.
Headache specialists tend to be neurologists or internists, so Dr. Guyuron’s work has notalways been taken seriously. “If I had a neurologist tell me there’s a new way of doing afacelift, I would have been very skeptical about it also,” said Dr. Guyuron, the chairman ofthe plastic surgery department at University Hospitals Case Medical Center in Cleveland.
“But honestly I would have had an open mind.” What you get for . $220,000
In the last month, the press has made much of the fact that a single operation could relieve migraines and turn back the clock in one fell swoop. But it is the potential that surgery for Cameron Mathison's brownstone is on the market migraines may offer a viable alternative to drugs that has migraine specialists intrigued. “A Gisele Bündchen's town house is on the market very large subset became headache-free and remained headache-free for a year — that is afantastic result,” said Dr. Richard B. Lipton, the director of the Montefiore HeadacheCenter in the Bronx.
Especially considering that in the field of migraines, success is defined “as a reduction of50 percent of attacks,” Dr. Cady said. Going from 10 episodes monthly to 5 is a welcomechange, he added, but “it’s still a lot of migraines.” The theory behind the surgery is that because some migraines are caused when sensitivenerve branches are squeezed and irritated by muscles, deactivating those muscles couldbring prolonged relief. In the off-label use of Botox for migraines, those same muscles —when paralyzed with Botox injections — have eased headaches in some patients for roughlythree months. Forehead lifts, Dr. Guyuron reasoned, might result in a longer-lasting,perhaps permanent, alleviation of pain. Only study participants who responded positivelyto Botox were offered the surgery.
(Dr. Cady cautioned that the research on Botox as a treatment for chronic headaches is not Treat Stubborn Lines
Learn How to Reduce Stubborn Frown Lines Between the
yet ironclad. Allergan, Botox’s maker, is pursuing the approval of Botox as a treatment for chronic migraines by the Food and Drug Administration.) New York Plastic Surgery
Many headache specialists, Dr. Lipton and Dr. Cady included, emphasize that this migraine New York's Top Plastic Surgeons New York Prices, Surgeons &More surgery isn’t applicable to most sufferers. “Folks who are appropriate for this procedure — they are the tip of the iceberg, not the vast majority,” said Dr. Jennifer S. Kriegler, a Nose Surgery Expert, NYC
neurologist who is one of the study’s authors and who works at the Cleveland Clinic’s Selected as One of The World's Top Nose Surgeons. Seen onFox5, Times At this stage, suitable candidates are those who endure frequent migraines and have failedmore tried-and-true methods of controlling their headaches, several doctors said. Thebottom line, Dr. Lipton explained, is if you can’t identify a point of irritation and “if youdon’t respond to Botox, we don’t know if this treatment works for you.” Some doctors fear that the surgery may be offered to inappropriate patients before furtherresearch confirms its efficacy for a broader group of patients. “I don’t want us to overshootand start doing widespread surgeries in not very well selected patients until we areconvinced this is broadly effective,” said Dr. F. Michael Cutrer, the chief of the headachedivision in the neurology department at the Mayo Clinic in Rochester, Minn. “You canalways stop a medication but you can’t reverse a surgery.” As word of the surgery spreads, Dr. Cutrer said that he anticipated pleas for referrals tothe few plastic surgeons nationwide who offer the operations, but that “until we maybehave studies that are a bit larger, and some longer follow-up I’m going to be very cautious.” So far, Dr. Guyuron has trained roughly 150 doctors, and other plastic surgeons arerefining their own migraine operations, even though they barely advertise.
Two years ago, an aunt told Shannon Byrne, from Mayfield Heights, Ohio, about Dr.
Guyuron’s migraine surgery. Ms. Byrne said that she had already spent a decade on “everysingle medication you can think of.” Still, pain hammered her head more days than not.
Skin Deep - Plastic Surgery That May Also Relieve Migraines - NYTimes.com
“You’re willing to try anything,” she said. Dr. Guyuron’s surgery, which she had 18 monthsago, was a godsend. The migraines that led to her dropping out of college and to a stroke at20 are gone. “My dad told me not to worry about the money,” Ms. Byrne, now 22, said ofthe thousands paid out of pocket.
A classic forehead lift for cosmetic effect differs significantly from surgery for migrainesufferers. The latter removes frown muscles more thoroughly and entails padding nerveswith fatty tissue, said Dr. David A. Branch, a plastic surgeon in Bangor, Me., who performsmigraine operations.
Sometimes, migraine surgery doesn’t involve the forehead at all. It varies according towhere the patient’s trigger sites are: forehead, temples or back of the head. If Dr. Guyuronoperates on the temples, the eyebrows are rejuvenated, he said. It is only the surgery atthe back of the head that has no added perk, he said.
It’s unclear whether or not the migraine sufferers whose pain had disappeared a yearpost-operation will remain headache-free for life.
“My goal is zero headaches,” said Dr. Jeffrey E. Janis, a plastic surgeon in Dallas, who hasperformed roughly 100 operations in the last five years after training with Dr. Guyuron. “Imight be able to achieve that in some, not in all.” Complete elimination is “a pretty strong claim after one year of follow-up,” Dr. Cutrer said.
As a way of dampening expectations, Dr. Kriegler, who has referred patients to Dr.
Guyuron, frequently tells them: “Once a migraineur, always a migraineur.” This article has been revised to reflect the following correction: Correction: September 10, 2009
An article last Thursday about plastic surgery that helps relieve migraines misstated
the month in which the success of such operations was first reported. It was August,
not this month.

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