Plastic surgery for migraines?
During the 35 years she suffered from frequent migraines so severe they made her vomit, Viera Bernat said she tried nearly every treatment imaginable. She changed her diet, practiced relaxation exercises and took a string of powerful drugs, from narcotic painkillers to Imitrex, one of a class of medications called triptans.
Nearly three years ago, as part of an experimental study, Bernat had her forehead lifted and her nose reshaped by Cleveland plastic surgeon Bahman Guyuron. For several months before the outpatient surgery, Guyuron had injected the anti-wrinkle drug Botox, also known as botulinum toxin A, into sites on Bernat's face and the back of her neck to determine if the paralytic drug reduced her headaches. Based on the results of those injections, Guyuron decided that muscles or tissue underlying those spots should be surgically removed to treat her pain.
To Bernat's delight, the surgery worked. Although she occasionally gets minor headaches and her forehead still feels numb, her weekly migraines have stopped. "I feel that I have my life back," she said. "I am so grateful." No one knows what causes migraines, which affect an estimated 28 million Americans, according to the National Institutes of Health. The condition, which often surfaces before age 35, appears to be a neurological problem linked to inherited abnormalities in genes that affect certain brain cells, rather than the dilation of blood vessels in the head, as scientists had long theorized.
Many neurologists say they are skeptical of Guyuron's hypothesis - that removing muscles pressing on nerves will quell migraine pain - as well as the methodology of his latest study, which assigned four times as many patients to the treatment group as to the control group. Some critics point out that Guyuron performed a variety of procedures on the patients, making it impossible to evaluate the success of treatment. Nearly all had a forehead lift, which involved removing the corrugator muscles, while 70 percent had an operation to straighten a deviated nasal septum (the cartilage and bone that separates the nostrils) and 38 percent had a portion of the greater occipital muscle from the back of the neck removed.
Nearly three years ago, as part of an experimental study, Bernat had her forehead lifted and her nose reshaped by Cleveland plastic surgeon Bahman Guyuron. For several months before the outpatient surgery, Guyuron had injected the anti-wrinkle drug Botox, also known as botulinum toxin A, into sites on Bernat's face and the back of her neck to determine if the paralytic drug reduced her headaches. Based on the results of those injections, Guyuron decided that muscles or tissue underlying those spots should be surgically removed to treat her pain.
Many neurologists say they are skeptical of Guyuron's hypothesis - that removing muscles pressing on nerves will quell migraine pain - as well as the methodology of his latest study, which assigned four times as many patients to the treatment group as to the control group. Some critics point out that Guyuron performed a variety of procedures on the patients, making it impossible to evaluate the success of treatment. Nearly all had a forehead lift, which involved removing the corrugator muscles, while 70 percent had an operation to straighten a deviated nasal septum (the cartilage and bone that separates the nostrils) and 38 percent had a portion of the greater occipital muscle from the back of the neck removed.