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New Procedure Treats Severe Migraines without Endoscope

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Study at Massachusetts General finds migraine symptoms eliminated in more than half of sufferers

A new version of an existing surgical procedure used to treat severe chronic migraines offers some degree of relief in more than 90% of patients who underwent the procedure at Massachusetts General Hospital.  Doctors at the hospital’s division of Plastic and Reconstructive Surgery found that more than half of the 35 patients who are treated with the non-endoscopic version of the procedure to treat migraine headaches caused by compression of craniofacial nerves were completely free of their migraine symptoms a full year after the procedure. The study can be found in the Journal Plastic and Reconstructive Surgery.

William G. (Jay) Austen, Jr., MD, chief of Plastic and Reconstructive Surgery at MGH, who led the study, said that his team found the surgery using the same incisions used in cosmetic procedures were highly effective for treating many cases of severe migraine. Formerly, this procedure involves using an endoscope, which often made it impractical as some surgeons lack access to the equipment or are inexperienced with the equipment. The team hopes the non-endoscopic version will lead to wider availability of the treatment.

Dr. Bahman Guyuron, MD, a plastic surgeon in Cleveland, found that many patients with migraines who underwent cosmetic procedures involving the forehead experienced relief of their migraine symptoms. A number of studies by him and other researchers support the idea that compression certain terms can be an important factor in migraine symptoms for some patients. That some patients experience temporary relief after injections of botulinum toxin (Botox), which tends to release pressure and overactive muscles, offers additional support.

While the original version this procedure involved use of an endoscope to remove certain muscles, the Massachusetts team has focused on developing alternative methods for accessing specific areas of nerve pressure using the same types of incisions frequently used in cosmetic procedures.

Participants in the study all experienced chronic migraines confirmed by a thorough neurological exam and had not been able to get relief from more conventional therapies. All participants had experienced temporary symptom relief from Botox or nerve blocks. Trigger point specific to the patient’s were identified based on each individual symptoms and histories. The procedure was used to release the specific sites from muscles, connective tissue, bony structures, and blood vessels.

For the study, researchers looked at 35 patients who underwent 43 total procedures. Of the 43 procedures, 90.1% provided relief of symptoms defined as at least 50% improvement in frequency, duration, and severity. And 51.3% of the procedures patients experienced complete elimination of their symptoms, 28.2% of patients experienced at least 80% improvement, while the remaining 20.5% experienced between 50 and 80% improvement.

Austen points out that patient selection is crucial. Patients should undergo a thorough neurological evaluation prior to having the surgery. The procedure is still relatively new and studies are underway to develop better ways of determining which patients are good candidates for the procedure. The researchers are hoping to establish stronger evidence that the procedure will be successful when performed by other surgeons at other centers. It is too early to call this procedure a migraine cure, but the results do suggest that it can improve the quality of life for many patients.

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New Procedure Treats Severe Migraines without Endoscope
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