Surgical removal of trigger points on the face and head can significantly reduce the frequency and severity of migraine headaches, and in some cases totally eliminate them, investigators report.

The team at Case Western Reserve University in Cleveland, Ohio, first tried this approach after patients undergoing plastic surgery or treatment with Botox reported that their headaches had disappeared, lead author Dr. Bahman Guyuron told AMN Health.

“The patients can guide us as to where the headaches are coming from,” Guyuron explained. Up to four of these sites are then injected with Botox. If this produces at least a 50 percent reduction in intensity and/or frequency of headaches for at least 4 weeks, the site was considered for surgery.

“Depending on the response, we decide if they are good candidates for surgery,” Guyuron said.

In the current study, reported in the January issue of Plastic and Reconstructive Surgery, 89 migraine patients were randomly assigned to surgical treatment while 19 others served as a no-surgery control group.

After 1 year, 31 (35 percent) in the treatment group reported that they were completely free of migraines, while 51 (57 percent) reported improvement, compared with three control patients (16 percent).

The average number of days lost from work fell from 4.41 each month to 1.2 each month in the treatment group, but there was no change in the control group.

The annual cost of treating migraines was reduced from $7612 to $925 in the active treatment group.

Temporary side effects of the surgery included a dry or runny nose, intense scalp itching and minor hair loss.

Guyuron said patients who might be considered for surgical treatment are those who do not benefit from over-the counter medications, have side effects from conventional migraine medications or have headaches so frequently that they interfere with day-to-day activities.

“Even with a conservative estimate of 30 percent of migraine sufferers, we are talking about 9 million patients in the US who could benefit” from surgery, he said.

SOURCE: Plastic and Reconstructive Surgery, January 2005.