A paper appearing in this month’s issue of Plastic and Reconstructive Surgery suggests that a modified version of a surgical technique originally designed for a different purpose may be an effective treatment for some types of chronic temporal headache. Following the observation that some patients with migraine reported fewer headaches after undergoing cosmetic forehead lift procedures, plastic surgeons have increasingly regarded surgery as a treatment option for selected chronic headache presentations. The surgery addresses trigger sites that are linked to certain headache patterns. Severe temporal headaches can result from muscle spasms or enlarged blood vessels putting pressure on the zygomaticotemporal branch of the trigeminal nerve (ZTBTN) and the auriculotemporal nerve (ATN). The objective of surgery is to relieve this pressure, or to disconnect the nerve to forestall headache triggering.
The new technique seeks to simplify the procedure and thus “lower the bar to adoption” in the words of Ziv Peled, MD, author of the paper. It employs a surgical incision already familiar to many plastic surgeons, the Gillies incision, placed in the temple behind the hairline, to gain direct access to the ZTBTN and ATN. In 19 patients treated with the new technique, Dr. Peled reports that 16 reported at least a 50% reduction in headache symptoms. This was assessed using the Migraine Headache Score (MHI), with average MHI score decreasing from 132 points presurgery to 52 points postprocedure. None of the patients suffered complications and none showed visible scarring.
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A news story about the new technique, with link to the journal article, may be read here.