Posted by Bob Johnson (12.19.49.2) on August 22, 2000 at 08:33:54:
This is a nice example of how promising treatments can be accidental discoveries--when you have a doc who is observant enough to see the unexpected.
While the use of botox has gained some interest, there is very little on its use with migraine in MEDLINE and zero citations on use with cluster.
So, we keep our eyes open and see if something comes of this treatment.
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WESTPORT, Aug 22 (Reuters Health) - A chance finding in the aftermath of cosmetic surgery may lead to a cure for as many as 80% of migraineurs. Specifically, Dr. Bahman Guyuron and colleagues from Case Western Reserve University, in Cleveland, Ohio, have discovered a strong correlation between the removal of the corrugator supercilii muscle and the elimination or significant improvement of migraine headaches.
Dr. Guyuron told Reuters Health in an interview that in late 1999, he spoke with two patients who reported cessation of migraines after undergoing a forehead lift procedure.
"When the first patient told me, I thought it was coincidence," Dr. Guyuron said. "After a second patient repeated the same story, I decided that we'd better look into this."
He and his colleagues sent out questionnaires on migraine history to 314 consecutive patients who had undergone corrugator supercilii muscle resection during endoscopic, transpalpebral, or open forehead rejuvenation procedures.
Thirty-nine patients had headaches that fulfilled the criteria of the International Headache Society for migraine, they report in the August issue of Plastic and Reconstructive Surgery. Almost 80% of these patients reported elimination or improvement of the migraine headaches immediately after surgery, with follow-up averaging 47 months.
"I'm extremely enthusiastic about this finding," Dr. Guyuron said.
He believes that the branch of the trigeminal nerve that penetrates the corrugator supercilii is "pinched" by the muscle, initiating the cascade of biochemical events that leads to the migraine.
"We have compelling evidence to prove this theory," he said. "Botox injection works on a good number of patients with migraine headache. The only commonality between Botox injection and the surgical procedure is elimination of muscle function."
He added, "What's amazing is that the percentage of patients who respond to Botox, about 80%, is very similar to the results we saw following surgery."
Dr. Guyuron and his colleagues have begun a prospective study to confirm their results. Patients will be screened with a Botox injection into the corrugator supercilii muscle.
If their results hold up, "doctors will consider this as a modality," Dr. Guyuron said. "Considering that the procedure requires only a few days of recovery and that the surgery itself is only about a half-hour procedure, it really is going to be a justifiable situation," he concluded.
Plast Reconstr Surg 2000:106:428-433.