Surgery May Offer Relief from Migraines

A new surgical therapy offered by Baylor College of Medicine doctors at The Methodist Hospital may help relieve migraine headaches.

Howard Derman, M.D., director of the Baylor/Methodist Headache Clinic, and Norman Rappaport, M.D., a clinical associate professor of plastic surgery at Baylor, are collaborating on the treatment, which targets the nerves and muscles that may trigger migraine headaches.

“Evidence presented at the American Headache Society meeting suggests that if we relieve the pressure of the nerves that pierce the corrugator supercilli muscles, a set of muscles at the bridge of the nose, we may help relieve migraine,” said Derman, who is also a Baylor associate professor of neurology.

Several studies, including a Baylor Headache Clinic study, were presented at the American Headache Society Meeting, and showed that botulinum toxin, or Botox, is an effective treatment for headache. However, these studies involved injecting Botox at multiple sites in the forehead, temples and neck muscles.

The new therapy injects Botox into the corrugator supercilii muscles of the forehead. Botox paralyzes these muscles, relieving pressure on branches of the trigeminal nerve, which pierces the muscle.

In headache patients whose migraines were eliminated by Botox for up to three months, Rappaport will remove part of the corrugator supercilii muscle, which should relieve pressure on the nerve. He may also cut a part of one of the small branches of the trigeminal nerve in cases where patients have improved but still experience some migraines after treatment with Botox.

Data presented at the American Headache Society meeting showed that 95 percent of the 24 patients in the Case Western Reserve University study reported an improvement of their migraines. Forty-six percent reported complete elimination of their migraines. At least 50 percent reported an improvement in the severity or frequency of their headaches.

“We are excited to offer what we think will be a promising treatment for migraine,” said Rappaport, who is also the medical director of the Houston Center for Plastic Surgery. “Patients who qualify for this treatment, and have good results with the initial Botox injection, will be able to decide whether they want to continue with the injections or pursue the surgical procedure, which could be a permanent cure.”

Patients with migraine headache will be evaluated to determine whether they are candidates for this treatment, or other therapies currently available for migraine. For more information about treatment for migraine, call the Baylor/ Methodist Headache Clinic at (713) 798-4865.

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©2006 Texas Medical Center

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