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Jury Still out on Forehead Lifts to Treat Migraines

By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent


A newly published study suggests that patients with severe migraines may benefit from an operation usually performed to get rid of crow's feet or other wrinkles, but some surgeons say more evidence is needed before they will begin to do forehead lifts to treat migraines.

"I would say the jury is still out," says Dr. Samuel Lin, plastic surgeon at Beth Israel Deaconess Medical Center and assistant professor of surgery at Harvard Medical School. "It is too soon to tell. More studies will need to be done."

One study published this summer compared 75 patients with migraine trigger sites in just one area. They got either a real forehead lift or a sham surgery. The patients were not told which type of surgery they were getting.

Those in the group that got the real surgery, nerves were cut at specific sites. In some cases, the nerves cut were those to eliminate crow's feet. Others had nerves cut that were involved in frown lines in the forehead.

A year later, 83 percent of those who got the real surgery reported at least a 50 percent reduction in migraines. By comparison, 57 percent of those in the sham surgery group reported a 50 percent reduction.

However, 57 percent of those in the real surgery group reported complete elimination of their migraines, while only 4 percent of those in the sham group said their migraines were completely eliminated.

The study, done at Case Western Reserve University in Ohio, appeared in the August issue of the journal Plastic and Reconstructive Surgery.

"Even the most skeptical people will have to accept there is something to this," Dr. Bahman Guyuron, the plastic surgeon who led the study, said at the time.

Dr. Lin of BIDMC says that the procedure has potential, but adds, "it is still early in the process of seeing if this is truly the treatment of choice for the majority of patients."

Dr. Lin says he is not performing forehead lifts for treatment of migraines and does not know any plastic surgeons in the Boston area who are doing so as the primary focus of their treatment of migraine headaches.

He says injections of Botox -- Botulinum Toxin Type A -- at trigger points have shown potentially promising results for migraines, as have trigger point injections of steroids and pain relievers.

The forehead lift involves incisions in the area of the scalp to allow for the forehead to be lifted off the bone, stretched and refixed to the bone. It is often done under general anesthesia, although it can be done with a local anesthesia.

Before it gains widespread acceptance, however, Dr. Lin says the procedure should be compared to Botox treatments and other current treatments and says it should only be done after other less invasive treatments are tried and found to fail.

Guyuron agreed that the treatment is not a good option for those with infrequent migraines or for those who respond to preventative treatments.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2009

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