Several years ago, a few plastic surgeons reported some of their patients experienced a reduction or elimination of migraine symptoms after cosmetic brow lifts. Physicians theorize the brow lift surgery cut through the muscle that had been irritating a nerve associated with the migraine symptoms. Janis says migraines may be triggered by nerves in several different areas of the head
He and a colleague mapped potential nerves and tried to identify areas where the nerves could be compressed. Then, to evaluate the possible outcome of surgery, he uses injections of BOTOX® in the trigger points. BOTOX (Botulinum Toxin Type A) is a toxin derived from a bacteria associated with food poisoning. When a small dose is injected under the skin, it causes a temporary paralysis in the target muscle. For patients with migraines, the BOTOX injection targets the muscle that may trigger the migraine. If the injection stops the migraine, the patient may be a good candidate for surgery.
First, the migraine trigger point(s) must be identified. A trigger point may be located in the brow, forehead, near the eyes, side of the head or in the back of the head. Janis says he targets one point at a time, starting with the area most associated with the migraine. Patients keep a diary of their headache symptoms and report back to him in 30 days. If the headaches continue, a BOTOX injection is given in another trigger point. Next, once the correct trigger points have been identified, the patient is scheduled for surgery.
A small incision, hidden by the hairline, is made into the skin. A tiny camera is inserted through the incision to allow Janis to visualize the muscle. Then a small amount of muscle is removed. A section of the nerve may also be removed. Ideally, the treatment will alleviate symptoms by preventing the onset of migraine symptoms. Since the surgery is a relatively new concept, no one knows how long the effects will last.
Janis says patients who are considering surgery for migraines need to have a thorough neurological examination. The treatment is usually only recommended for those who have not had relief with traditional treatments.
There are some risks to the treatment. In some patients, injection of BOTOX or use of surgery can trigger a migraine. BOTOX can also cause drooping of the eyebrow or eyelid, weakness of the chewing muscles, double vision and neck soreness or weakness. Janis also warns patients that although many physicians use BOTOX to treat migraine, the drug is not FDA approved for this purpose.