FED: Wrinkles need no longer be a headache
By Judy Skatssoon, National Medical Writer
SYDNEY, Aug 13 AAP - It may be possible to cure migraine by surgically removing musclesfrom the forehead, face or back of the neck, a medical conference in Sydney was told.
US plastic surgeon Bahman Guyuron said he stumbled upon the discovery after performingbrow lifts on patients to get rid of their wrinkles.
During a brow lift, the skin of the forehead is cut open and the surgeon removes musclesand replaces them with fat harvested from the patient's cheekbones.
The procedure - a more radical alternative to Botox injections - is currently performedon several thousand Australians a year, local plastic surgeons estimate.
Dr Guyuron said his investigations began almost four years ago when brow lift patientswho also suffered from migraines told him their headaches had disappeared after surgery.
A study he published in 2002 reinforced evidence that the majority of migraine suffererswho underwent brow rejuvenation through Botox or surgery experienced a total eliminationor reduction of migraine pain.
At the same time other studies were linking Botox with migraine relief.
Dr Guyuron reasoned the common link was that both Botox and surgery acted on musclesthat appeared to be linked to migraine.
"What happens is when we frown these muscles contract along the nerves and it createsinflammation that travels along the nerve, reaching the brain membrane," he said.
"In migraines the muscles act like a trigger, it's like a domino effect.
"By removing the muscle we're removing the culprit and eliminating the potential formigraine headaches."
Dr Guyuron's explanation turns on its head other theories of migraine which suggestthe pain begins in the brain and travels outwards.
He is currently halfway through a five year-study involving 125 patients, including100 who had either botox or surgery and 25 receiving placebo injections.
The injections and surgery target muscles in the forehead, back of the neck and nose,which Dr Guyuron said were all linked to nerves that could cause migraine.
So far, of the 91 patients who had surgery 79 had reported a beneficial effect in termsof migraine, Dr Guyuron told the World Congress of Plastic Surgery in Sydney.
Dr Guyuron said while brow muscle removal had begun as a purely cosmetic procedureit was now being used to treat migraine.
Melbourne aesthetic plastic surgeon Bryan Mendelson said Dr Bahman's evidence was "compelling"
and the procedure could easily be performed in Australia.
"In Australia plastic surgeons already do brow lifts," he said.
"These are tried and true surgical procedures, it's a matter of ... learning the particularnuances of what he's doing."
Dr Guyuron's studies offered "a whole different way of thinking about managing migraine,"
Dr Mendelson said.
"What he has done is found serendipitously that this really does work," he said.
AAP jjs/mg/de
KEYWORD: MIGRAINE
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