A Cleavland Plastic Surgeon, Bahman Guyuron, made an interesting observation a few years ago when he was told by several of his brow lift patients that their migraine headaches went away after surgery. Working from that feedback he hypothesized that surgical release of several muscles that are divided to improve forehead wrinkle line act as trigger points for migraines. Eventually this led to the therapeutic use of BOTOX cosmetic for treating migraines, which has become quite a big business for neurologists.
Ironically, there were a number of Neurologists who initially aggressively protested that it was impossible for BOTOX to have an affect because Neurology dogma had migraines originating from central brain triggers rather then peripheral ones. However, the studies that have been published since have been overwhelmingly compelling for how effective this type of therapy can be in selected patients.
The graphic below demonstrates the classic central forehead/nasal injection pattern for paralyzing the procerus and corregator muscle groups which are the muscles divided in some brow lift procedures.
For several years in the Plastic Surgery literature we’ve been trying to better quantify who would be candidates for planned surgical division of 3 or 4 muscles for treating migraines with surgery for a permanent cure. The anatomy and refinements of surgical techniques for this are being developed by an acquaintance of mine, Dr. Jeff Janis (seen in picture at right), at the University of Texas-Southwestern in Dallas,TX. Jeff’s been featured in a bunch of stories on this recently (see here)which is great for such a bright guy.
I ran into Dr. Janis at the Dallas Rhinoplasty meeting last week where he was about to commence a marathon cadaver dissection to study the anatomy in dozens of fresh human cadaver heads that had been used as part of the rhinoplasty course. The work he’s doing is really developing an area that has tremendous potential to help some patients suffering from this terrible condition.
