Migraine headaches affect about 30 million people in the United States. They may occur at any age, but they usually begin between the ages of 10 and 40 and diminish after age 50. Some people experience several migraines per month, while others have only a few migraines throughout their lifetimes. Approximately 75% of migraine sufferers are women.

A study in Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons, reports that migraine headache sufferers get significant relief or elimination of symptoms through surgery to remove the corrugator supercilii muscles (vertical frown muscles) in the forehead.

“Recent studies in the field of plastic surgery have examined the role of surgery in patients with migraine headaches refractory to conservative therapy,” says Peter J. Taub, MD, FACS, FAAP, who practices in New York City. “Patients with all grades of severity were noted to have improvement with outpatient corrugator muscle resection. Those patients with milder symptoms were noted to experience more uniform improvement, and vice versa.”

The cause of migraine is unknown. The condition may result from a series of reactions in the central nervous system caused by changes in the body or in the environment. There is often a family history of the disorder, suggesting that migraine sufferers may inherit sensitivity to triggers that produce inflammation in the blood vessels and nerves around the brain, causing pain.

Migraine pain is often described as throbbing or pulsating pain that is intensified by routine physical activity, coughing, straining, or lowering the head. The headache is often so severe that it interferes with daily activities and may awaken the person at night. The attack is debilitating, and once passed it often leaves migraine sufferers feeling tired and weak.

A migraine typically begins in a specific area on one side of the head, spreads and builds in intensity over 1 to 2 hours, then gradually subsides. It can last up to 24 hours, and in some cases for several days.

There may be accompanying symptoms, such as nausea, vomiting, sensitivity to light (photophobia), or sensitivity to sound (phonophobia). Hands and feet may feel cold and sweaty, and unusual odors may be intolerable.

In the study, Bahman Guyuron, MD, and neurology colleagues at Case Western Reserve University in Cleveland studied 29 patients who suffered from migraine headaches. The patients ranged in age from 24 to 63 years.

To screen the migraine sufferers for surgery, Guyuron gave them botulinum toxin Type A injections to temporarily paralyze their corrugator muscles. Patients who reported improvement after the injections were recommended for surgery to remove the muscle.

Guyuron says his discovery of the surgical technique came after several patients who had forehead lifts reported migraine relief. This led him to the theory that many migraine patients have one or more of four “trigger points”: the forehead, the temple, the back of the neck, and the nose area. Muscles that contract around nerves in the face, he suggests, trigger a domino effect that results in migraine pain.

After receiving the injections in the corrugator muscle, 82% of patients (24 out of 29) noticed improvement or complete elimination of their head­aches, 55% had complete elimination of their head­aches, and 28% had significant improvement for 6 or more consecutive weeks. Patients had migraines less often—down from six to two per month—and their headaches were less severe.

Twenty-two patients who responded favorably to botulinum toxin Type A treatment were considered suitable candidates for surgery. Of those patients, 95% (21 patients) had improvement of their headaches; 45% reported elimination of their headaches; and 50% noted a significant improvement of their symptoms. The average headache intensity for the entire surgical group fell considerably, and the headache frequency decreased from five to less than one per month.

“The results of this study are truly encouraging,” Guyuron says. “Since 95% of patients responded positively to surgery without significant complications, we can conclude that surgical treatment of migraine headaches is both safe and successful. Even in patients who did not experience complete elimination of migraine headaches, the reduction in frequency achieved was remarkable. In addition, all patients received the added bonus of a rejuvenated forehead.”

The authors are continuing their research for a cure and are currently working on a larger, 125-patient, randomized study to find additional migraine trigger points to enable them to offer a greater chance for their elimination.